The views of health care providers’ (HCPs) and patients with Chronic Obstructive Pulmonary Disease (COPD) on pain in pulmonary rehabilitation (PR): A qualitative study

Abstract

Introduction: 66% of patients with COPD involved in PR report pain. To help inform a COPD-specific pain intervention we explored the views of HCPs and COPD patients on pain during PR. Methods: A qualitative study using inductive thematic analysis. Eighteen HCPs familiar with PR and 19 patients enrolled in PR participated in semi-structured interviews. Demographic data was recorded and patients completed the Brief Pain Inventory. Results: 1. Pain interfering with COPD: breathing effort causes thoracic pain, heightened by combined breathlessness and anxiety. 2. Pain interfering with PR: a. Communicating pain; HCPs emphasized that patients should report pain. However they are reluctant to do so for fear of being removed from PR. b. PR is a short-term aggravator but long-term reliever; pain hinders exercise completion and can lead to dropout, although in the long-term PR strengthens and supports pain coping. c. Advice and strategies for pain; the focus of HCPs in PR is dyspnoea. Some adaptations are made but patients’ recall instructions to cease exercise, which promotes trust. 3. A pain intervention: distraction, mindfulness and education were considered useful techniques to target pain in COPD. The preferred delivery mode was group education at the start of PR with one-on-one support if required. HCPs recognized gaps in their knowledge regarding pain management. Conclusions: Pain is common and a COPD-specific pain intervention as part of PR education might encourage PR completion and clinical benefit. Additional HCP training is required.