Heart Failure: The Hidden Problem of Pain

Although dyspnea and fatigue are hallmark symptoms of heart failure (HF), the burden of pain may be underrecognized. This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67 +/- 11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2).,Single items from the BPI interference and the quality of life-end of life measured social and spiritual Well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with, pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pair >= 4/10). The Presence of pair, was reported more frequently than dyspnea (67 [71.3%] vs. 58 [61.7%]). Age (P = 0.02), psychological (depression: P = 0.002; anxiety: P= 0.001), social, (P < 0.001), spiritual (P= 0.010), and physical (health. status: P = 0.001; symptom frequency: P = 0.000; functional status: P = 0.002) well-being were correlated with pain severity. In the resulting model, 38% of the. variance in pair, severity was explained, (P < 0.001); interference with relations (P < 0.001) and symptom number (P = 0.007) contributed, to pain severity. The association of physical, psychological, social, and spiritual domains With pain suggests that multidisciplinary interventions are needed to address the complex nature of pain in HE J Pain Symptom Manage 2009;38:698-707. (C) 2009 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.