Pain is a significant issue for patients with chronic obstructive pulmonary disease (COPD); however, current research lacks details with respect to the types of nonparmacologic and noninvasive interventions that effectively mitigate pain in this population, according to findings reported in Respiratory Medicine.
Although chronic pain is common among patients with COPD, pharmacological pain management appears ineffective in this population and chronic pain management is not addressed in current COPD guidelines. Researchers therefore conducted a systematic review to determine the efficacy of existing nonpharmacological and noninvasive interventions — including behavior change techniques (BCTs) — for addressing chronic pain in those with COPD.
A search of 14 databases was conducted from May to June 2020, with an updated search for May to August 2022. Eligible studies were any nonpharmacologic, noninvasive intervention-based studies, with both randomized and nonrandomized controlled designs, that included patients with a confirmed diagnosis of stable COPD (ie, Global Initiative for Chronic Obstructive Lung Disease stages 1-4). Outcomes of interest were pain measures or pain subscale scores. Chronic pain was defined as pain occurring for at least 3 months with no underlying tissue damage in its etiology.
The final review included 29 studies with 3228 participants. Of the studies, 25 were randomized controlled trials (RCT) and 4 had non-RCT designs, 1 with a mixed methods approach.
In 7 studies, a clinically meaningful change in pain outcomes (minimal clinically important difference of ≥1) from pre-intervention to postintervention was reported, although only 2 studies were statistically significant (P <.001). A third study did not find a clinically meaningful improvement but did show statistical significance (P =.0273).
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Future research should describe interventions in detail and more frequently assess pain in this population to inform the development of an intervention targeting pain management for people with COPD.
The absence of reporting of intervention descriptions made extraction of BCTs difficult, according to the study authors. When information about intervention content was included, the BCT was reported to include “instructions on how to perform the behaviour” and “goal setting.” Moreover, these BCTs did not specifically target pain, but rather a range of interventions for multiple primary outcomes. In 7 studies involving BCT, all interventions with a clinically meaningful improvement in pain outcomes reported a degree of instruction for study participants.
Baseline pain, SF-36 Physical Component score (PCS), and SF-36 Mental Component score (MCS) outcome measures were extracted from each intervention and control group when possible. Mean pain scores ranged from 8.15 to 77.50 with an overall weighted mean of 54.53. Excluding outliers in 1 study resulted in a range of 35.1 to 77.5, with a weighted mean pain score of 55.90. The weighted mean PCS and MCS scores were 33.34 and 42.43, respectively.
Regarding the quality of evidence, 5 RCTs had a low risk of bias, 8 had a moderate risk of bias, 12 indicated a high risk of bias, and the 4 non-RCTs had a moderate risk of bias.
A significant limitation reported by researchers involved BCT. BCT protocols require that interventions are coded only when the BCT is explicitly reported in the intervention description, and this process was limited by the detail of intervention methodology reported within each study.
“As it stands, the conduct of our systematic review does not enable us to recommend a specific intervention to improve pain in people with COPD,” stated the study authors. “There appears to be an element of ‘brain retraining’ for pain management missing to make the intervention more effective. Future research should describe interventions in detail and more frequently assess pain in this population to inform the development of an intervention targeting pain management for people with COPD.”
