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Study shows COPD is associated with significant and persistent pain

May 21, 2013

ATS 2013, PHILADELPHIA - Chronic obstructive pulmonary disease (COPD) is primarily associated with the respiratory symptoms that are its hallmark, but in fact, patients who struggle with the disease also experience significant amounts of chronic pain. A new study conducted by researchers in Pennsylvania and New Mexico estimates the degree of pain suffered by these patients to be close to that experienced by patients with osteoarthritis and rheumatoid arthritis.

The research results will be presented at the ATS 2013 International Conference.

"Several studies have found high rates of pain medication use among COPD patients, and pain has also been an important determinant of overall health status and quality of life in COPD," said study lead author Melissa Roberts, MS, senior research associate at the Lovelace Clinic Foundation in Albuquerque and a doctoral candidate at the University of New Mexico College of Pharmacy.

"In prior studies, we had observed increased narcotic and non-narcotic pain medication use among individuals with COPD and were interested in whether this was because the COPD population tends to be older and have more comorbidities, or whether there might be an association between COPD and pain above and beyond what age and comorbidities might explain," she said. "In this study, we chose to compare chronic pain in individuals with COPD and individuals with chronic conditions that similarly affect multiple body systems."

The retrospective study used data gathered from 7,952 COPD patients and 15,904 non-COPD patients over the age of 40 who were enrolled in a managed care system in the southwestern United States from 2006 through 2010. The presence of pain was determined by pain-associated diagnosis codes, the use of pain therapy and outpatient prescription claims for pain medication, and recurrent therapy and prescriptions were considered evidence of chronic pain.

The researchers found that compared to those with non-COPD chronic disease, a greater number of patients with COPD had some indication of chronic pain and use of pain-related medications, including both short-acting and long-acting opioids. However, chronic pain was not associated with lung function impairment among the study patients, suggesting the causes of pain are not directly associated with airflow obstruction. The only subset of patients with greater prevalence of chronic pain and use of pain medication were patients with either rheumatoid arthritis or osteoarthritis.

"We found the prevalence of chronic pain among adults with chronic disease to be almost twice as high as among individuals without chronic disease," Ms. Roberts noted. "Among those with chronic disease, individuals with COPD were similar to those with rheumatoid arthritis or osteoarthritis in their experience of pain, but with even greater use of opioids."

An investigation of the incremental costs associated with chronic pain is under way, she noted.

"The socioeconomic impact of chronic pain on patients with COPD is also an understudied issue, and many health care organizations conduct management programs for chronic diseases which significantly impact quality of life," Ms. Roberts said. "Among individuals with COPD, pain may be having a marked impact on their quality of life, potentially as much as their respiratory disease, and contributing significantly to their cost of care."
* Please note that numbers in this release may differ slightly from those in the abstract. Many of these investigations are ongoing; the release represents the most up-to-date data available at press time.

Abstract 40849

Chronic Pain Among Individuals With COPD As Compared To Other Chronic Diseases

Type: Scientific Abstract

Category: 09.03 - COPD: Comorbidities (CP)

Authors: M.H. Roberts1, D.W. Mapel1, A. Hartry2, A. Von Worley1, H. Thomson2; 1Lovelace Clinic Foundation - Albuquerque, NM/US, 2Endo Pharmaceuticals - Chadds Ford, PA/US

Abstract Body

Rationale. Several studies have found high rates of pain medication use among COPD patients. Pain has also been an important determinant of overall health status and quality of life in COPD. This project's objective was to describe chronic pain prevalence among COPD patients as compared to similar patients with other chronic diseases, and to compare factors associated with chronic pain in a matched analysis of COPD and non-COPD patients, supplemented by a sub-analysis of patients with spirometry information.

Methods: In this retrospective analysis (1/1/2006 through 12/31/2010) of managed care system enrollees (age >40) in the Southwestern U.S. pain was indicated by pain-associated diagnosis codes, pain therapy, or outpatient prescription claims for pain medication; and recurrent occurrences of such utilization was considered evidence of chronic pain. Patients were matched on age, sex, insurance coverage, type of healthcare encounter, and encounter date (+/- 6 months).

Results: Adjusted prevalence rates were similar across all study years; for brevity, rates for 2010 are stated. A higher percentage of those with COPD compared to those with non-COPD chronic disease had some indication of chronic pain (61.8% vs 53.9%, P<0.05) and evidence of chronic pain-related medication use (48.1% vs 35.7%, P<0.05). Matched Analysis. The cohort consisted of 7,952 COPD patients (mean age 69 years) and 15,904 non-COPD patients (mean age 68 years), 58% of whom were female. Evidence of chronic pain was similar to the unadjusted prevalence rates (COPD=59.8%, non-COPD=51.7%, P<0.0001). Non-COPD rheumatoid/osteoarthritis (RA/OA) patients had greater evidence of chronic pain (70.2%, P<0.0001) and chronic use of pain-related medications compared to COPD patients (44.8% vs 41.2%, P<0.0001), but for all other conditions, a higher percentage of COPD patients vs non-COPD had chronic use of pain-related medications (41.2% vs 31.5%, P<0.0001). Of those with evidence of chronic use of pain medications, more COPD patients had chronic use of short-acting opioids (24.2% vs 15.1%, P<0.0001) and long-acting opioids (4.4% vs 1.9%, P<0.0001). Among COPD patients, chronic pain patients tended to be female (64.0% vs 49.0%, p<0.0001)with a greater number of comorbidities (3.3 vs 2.7, p<0.0001), inflammatory pain (86.5% vs 45.7%, P<0.0001), and an inpatient or institutional stay (42.7% vs 25.4%, p<0.0001). Chronic pain was not associated with lung function impairment. Conclusion: The majority of COPD patients experience chronic pain at a rate that is outmatched only by persons with RA/OA. Short-acting and long-acting opiate use among COPD patients is accordingly higher.

American Thoracic Society

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