Daily Dose: Chronic Pain Management for Patients with COPD

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On April 10, 2023, we reported on a study published in the journal Respiratory Medicine that evaluated the efficacy of existing nonpharmacologic and noninvasive interventions for addressing chronic pain in those with chronic obstructive pulmonary disease (COPD).

The study

Investigators conducted a search of 14 databases 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.

From an original yield of 95 302 potentially relevant studies, researchers assessed 223 for eligibility, with 29 studies (n=3228) included in the final review. Of the studies, 25 were randomized controlled trials (RCT) and 4 had non-RCT designs, 1 with a mixed methods approach.

The findings

A wide range of interventions were reported including physical rehabilitation, education, various forms of exercise, breathing management techniques, self-management, and psychotherapeutic interventions; most of the interventions were not targeted specifically at pain.

A clinically meaningful change in pain outcomes (minimal clinically important difference of ≥1) from pre-intervention to postintervention was reported in 7 studies, although results were statistically significant (P<.001) in only 2 studies, according to results. A third study did not find a clinically meaningful improvement but did show statistical significance (P=.0273).

Note from authors

"Pain appears to be a meaningful issue for many individuals with COPD. However, intervention heterogeneity and issues with methodological quality limit certainty about the effectiveness of currently available non-pharmacological interventions. An improvement in reporting is required to enable identification of active intervention ingredients associated with effective pain management."

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