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Dyspnea and pain frequently co-occur among Medicare managed care recipients.

Publication ,  Journal Article
Clark, N; Fan, VS; Slatore, CG; Locke, E; Whitson, HE; Nici, L; Thielke, SM
Published in: Ann Am Thorac Soc
July 2014

RATIONALE: 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. OBJECTIVES: We sought to ascertain the co-occurrence of pain and dyspnea by self-report in a large cohort of Medicare recipients. METHODS: 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. CONCLUSIONS: 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.

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Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

July 2014

Volume

11

Issue

6

Start / End Page

890 / 897

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Retrospective Studies
  • Pulmonary Disease, Chronic Obstructive
  • Pain
  • Obesity
  • Managed Care Programs
  • Male
  • Incidence
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Clark, N., Fan, V. S., Slatore, C. G., Locke, E., Whitson, H. E., Nici, L., & Thielke, S. M. (2014). Dyspnea and pain frequently co-occur among Medicare managed care recipients. Ann Am Thorac Soc, 11(6), 890–897. https://doi.org/10.1513/AnnalsATS.201310-369OC
Clark, Nathan, Vincent S. Fan, Christopher G. Slatore, Emily Locke, Heather E. Whitson, Linda Nici, and Stephen M. Thielke. “Dyspnea and pain frequently co-occur among Medicare managed care recipients.Ann Am Thorac Soc 11, no. 6 (July 2014): 890–97. https://doi.org/10.1513/AnnalsATS.201310-369OC.
Clark N, Fan VS, Slatore CG, Locke E, Whitson HE, Nici L, et al. Dyspnea and pain frequently co-occur among Medicare managed care recipients. Ann Am Thorac Soc. 2014 Jul;11(6):890–7.
Clark, Nathan, et al. “Dyspnea and pain frequently co-occur among Medicare managed care recipients.Ann Am Thorac Soc, vol. 11, no. 6, July 2014, pp. 890–97. Pubmed, doi:10.1513/AnnalsATS.201310-369OC.
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. Ann Am Thorac Soc. 2014 Jul;11(6):890–897.

Published In

Ann Am Thorac Soc

DOI

EISSN

2325-6621

Publication Date

July 2014

Volume

11

Issue

6

Start / End Page

890 / 897

Location

United States

Related Subject Headings

  • United States
  • Surveys and Questionnaires
  • Retrospective Studies
  • Pulmonary Disease, Chronic Obstructive
  • Pain
  • Obesity
  • Managed Care Programs
  • Male
  • Incidence
  • Humans