HSR&D Citation Abstract
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Dyspnea and pain frequently co-occur among Medicare managed care recipients.
Clark N, Fan VS, Slatore CG, Locke E, Whitson HE, Nici L, Thielke SM. Dyspnea and pain frequently co-occur among Medicare managed care recipients. Annals of the American Thoracic Society. 2014 Jul 1; 11(6):890-7.
Experimental and neuroimaging studies have suggested strong associations between dyspnea and pain. The co-occurrence of these symptoms has not been examined in community samples.
We sought to ascertain the co-occurrence of pain and dyspnea by self-report in a large cohort of Medicare recipients.
We analyzed data from 266,000 Medicare Managed Care recipients surveyed in 2010 and 2012. Dyspnea was defined by aggregating three questions about shortness of breath (at rest, while walking one block, and while climbing stairs). Pain was measured by four questions about pain interference, chest pain, back pain, and arthritis pain. All measures were dichotomized as high or low/none. We calculated the co-occurrence of pain and dyspnea at baseline, and generated logistic regression models to find the adjusted relative risk (RR) of their co-occurrence, adjusting for patient-level factors and three potential medical causes of dyspnea (chronic obstructive pulmonary disease/emphysema/asthma, congestive heart failure, and obesity). We modeled the simultaneous development and the simultaneous resolution of dyspnea and pain between baseline and 2 years.
MEASUREMENTS AND MAIN RESULTS:
Participants with dyspnea had considerably higher prevalence of pain than those without (64 vs. 18%). In fully adjusted models, participants with any of the types of pain were substantially more likely to report dyspnea than those without these types of pain (high pain interference: relative risk [RR], 1.99; 95% confidence interval [CI], 1.92-2.07; chest pain: RR, 2.11; 95% CI, 2.04-2.18; back pain: RR, 1.76; 95% CI, 1.71-1.82; and arthritis pain: RR, 1.49; 95% CI, 1.44-1.54). The relative risks of dyspnea developing or resolving at 2 years were greatly increased (RRs of 1.5 - 4) if pain also developed or resolved.
Pain and dyspnea commonly occurred, developed, and resolved together. Most older adults with dyspnea also reported pain. Medical conditions typically assumed to cause dyspnea did not account for this association. The most plausible explanation for the co-occurrence is physical deconditioning.