Abstract
Chronic pain is highly prevalent and more common in people with chronic obstructive pulmonary disease (COPD) than people of similar age/sex in the general population. This systematic review aimed to describe how frequently and in which contexts pain is considered in the clinical practice guidelines (CPGs) for the broad management of COPD. Databases (Medline, Scopus, CiNAHL, EMbase, and clinical guideline) and websites were searched to identify current versions of COPD CPGs published in any language since 2006. Data on the frequency, context, and specific recommendations or strategies for the assessment or management of pain were extracted, collated, and reported descriptively. Of the 41 CPGs (English n = 20) reviewed, 16 (39%) did not mention pain. Within the remaining 25 CPGs, pain was mentioned 67 times (ranging from 1 to 10 mentions in a single CPG). The most frequent contexts for mentioning pain were as a potential side effect of specific pharmacotherapies (22 mentions in 13 CPGs), as part of differential diagnosis (14 mentions in 10 CPGs), and end of life or palliative care management (7 mentions in 6 CPGs). In people with COPD, chronic pain is common; adversely impacts quality of life, mood, breathlessness, and participation in activities of daily living; and warrants consideration within CPGs for COPD.
Highlights
In people with chronic obstructive pulmonary disease (COPD), persistent pain is a common clinical issue adversely impacting daily function, symptom burden, and quality of life [1,2,3]
Chronic pain is common in people with COPD and adversely impacts quality of life, mood, breathlessness, and participation in physical activity and activities of daily living
Few clinical practice guidelines (CPGs) address the symptom of pain
Summary
In people with chronic obstructive pulmonary disease (COPD), persistent pain is a common clinical issue adversely impacting daily function, symptom burden, and quality of life [1,2,3]. Interval (CI) 44–85%) [2] These estimates are likely influenced by the clinical context of the sample (e.g., stable, acutely unwell, or end of life), sampling source (e.g., outpatients, pulmonary rehabilitation, and population), assessment instrument, and focal period (e.g., past week, month, and year). Excluding studies where the prevalence is likely to reflect acute pain associated with hospital presentation or end of life care, the majority of studies reflect persistent or chronic pain reported by people participating in pulmonary rehabilitation, attending routine outpatient appointments, or of the broader community. Compared to the general community, large population-based studies report higher rates of persistent pain in people with COPD for (1) “usual” chronic non-cancer pain
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