Pain Control Lacking in End-Stage COPD Patients
Most people hear "hospice" and think "cancer," but many end-stage chronic obstructive pulmonary disease patients also receive hospice care when their caregivers can no longer provide the medical attention they need.
Most people hear “hospice” and think “cancer,” but many end-stage chronic obstructive pulmonary disease (COPD) patients also receive hospice care either at home or an inpatient facility when their caregivers can no longer provide the medical attention they need.
While pain is a frequent occurrence in patients with end-stage COPD, few studies have examined its unique characteristics, until now.
For a recent study published in Palliative Medicine, investigators from research facilities across the United States and Israel retrospectively reviewed the medical charts of 146 patients with terminal diseases who were referred for inpatient hospice care. The researchers teased out unique pain characteristics among 51 end-stage COPD patients, 48 dementia patients, and 47 cancer patients admitted to an acute inpatient hospice setting between April 2011 and March 2012.
To determine whether the end-stage COPD patients’ pain was treated differently, the authors assessed associations among pain characteristics, medication utilization, and admission diagnoses.
Patients frequently reported pain regardless of their diagnoses, though admission diagnosis was the strongest predictor of pain control. Cancer patients reported more severe pain on admission than others, and they received a significantly higher cumulative opioid dose compared with dementia and COPD patients.
Overall, <50% of all patients reported pain control within 24 hour of pain onset. In dementia and cancer patients, pain control was achieved in 64% and 41% of patients, respectively. COPD patients were the least likely to achieve adequate pain control, with only 28% reporting pain control at 24 hours.
Patients with COPD who had moderate-to-severe pain received significantly less opioid medication compared with cancer patients. The investigators suggested that providers should prescribe opioids only reluctantly to COPD patients, fearing the possibility of respiratory depression. Clinicians may also be distracted by COPD patients’ dyspnea and under-estimate their pain intensity.
The authors reminded clinicians that the American College of Chest Physicians endorses opioid use to manage dyspnea in patients with advanced lung disease.