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Original Research |

Pain Is a Common Problem Affecting Clinical Outcomes in Adults With Cystic FibrosisPain in Cystic Fibrosis

Margaret Hayes, MD; Myron Yaster, MD; Jennifer A. Haythornthwaite, PhD; Kristin A. Riekert, PhD; Kristen Nelson McMillan, MD; Elizabeth White, RN, MSN; Peter J. Mogayzel, Jr, MD, PhD, FCCP; Noah Lechtzin, MD, FCCP
Author and Funding Information

From the Department of Internal Medicine (Dr Hayes), the Department of Anesthesiology and Critical Care Medicine (Drs Yaster and Nelson McMillan and Ms White), the Department of Psychiatry and Behavioral Science (Dr Haythornthwaite), the Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine (Drs Riekert and Lechtzin), and the Department of Pediatrics, Division of Pulmonary Medicine (Dr Mogayzel), Johns Hopkins University School of Medicine, Baltimore, MD.

Correspondence to: Noah Lechtzin, MD, FCCP, 1830 E Monument St, 5th Floor, Baltimore, MD 21205; e-mail: nlechtz@jhmi.edu

Data are presented as % unless indicated otherwise. Some cells do not add up to 100% because of missing data or rounding off.

a

Includes yoga, meditation, chiropracty, and massage.

Depression and anxiety scores were higher in those with pain in the past 7 days than in those without. Quality of life was worse when pain was present.

a

Composite pain score of pain in the past 7 days.

Funding/Support: This work was supported by the Jacob and Hilda Blaustein Pain Foundation and the Osler Fund for Scholarship, Johns Hopkins University.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: This work was supported by the Jacob and Hilda Blaustein Pain Foundation and the Osler Fund for Scholarship, Johns Hopkins University.

Funding/Support: This work was supported by the Jacob and Hilda Blaustein Pain Foundation and the Osler Fund for Scholarship, Johns Hopkins University.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1598-1603. doi:10.1378/chest.11-0132
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Background:  As the cystic fibrosis (CF) population has aged, many chronic health problems have emerged, including diabetes mellitus and osteoporosis. Previous studies have suggested that pain is common in patients with CF; however, little is known about the factors associated with it or its impact on clinical outcomes. We hypothesized that pain is common, is associated with psychologic distress, and adversely affects clinical outcomes.

Methods:  From February 1, 2008, to April 3, 2008, adults with CF from Johns Hopkins Hospital were surveyed about their pain. Outcomes were assessed for 12 months following survey completion. Bivariate analyses were performed using Wilcoxon log rank, Kruskal-Wallis tests, and Spearman correlations. Logistic regression models and Cox proportional hazard models were used to analyze clinical outcomes.

Results:  Eighty-three patients (61%) completed the survey. Eighty-two percent of patients reported pain within the past month, the most common sites being the head, sinuses, back, and chest. Pain frequently interfered with general activities (41.9%), mood (56.8%), and work (47.3%). Symptoms of depression and anxiety, as well as lower quality-of-life (QOL) scores, were associated with the presence of pain (P < .05 for each). The risk of pulmonary exacerbations was increased in patients with higher levels of pain, even after adjusting for FEV1 and age (OR = 1.65; P = .038; 95% CI, 1.03-2.64). Additionally, the risk of death was higher in patients with higher average pain scores (HR = 2.28; P = .008; 95% CI = 1.2-4.2).

Conclusions:  Pain is common in adults with CF, interferes with activities, and is associated with lower QOL and an increased risk of both exacerbations and death.

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