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The role of pain in pulmonary rehabilitation: a qualitative study

Authors Harrison SL, Lee AL, Elliott-Button HL, Shea R, Goldstein RS, Brooks D, Ryan CG, Martin DJ

Received 3 July 2017

Accepted for publication 8 September 2017

Published 8 November 2017 Volume 2017:12 Pages 3289—3299

DOI https://doi.org/10.2147/COPD.S145442

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

Samantha L Harrison,1 Annemarie L Lee,2–4 Helene L Elliott-Button,1 Rebecca Shea,5 Roger S Goldstein,2,3,6 Dina Brooks,2,3 Cormac G Ryan,1 Denis J Martin1

1School of Health and Social Care, Teesside University, Middlesbrough, UK; 2The Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON, Canada; 3Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; 4School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia; 5The Rehabilitation Centre, South Tees Hospital NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK; 6Department of Medicine, University of Toronto, Toronto, ON, Canada

Introduction: One third of individuals with chronic obstructive pulmonary disease (COPD) report pain. To help inform a COPD-specific pain intervention, we explored the views of health care providers (HCPs) and individuals with COPD on pain during pulmonary rehabilitation (PR).
Methods: This is a qualitative study using inductive thematic analysis. Eighteen HCPs familiar with PR and 19 patients enrolled in PR participated in semi-structured interviews. Demographic data were recorded, and the patients completed the Brief Pain Inventory (Short Form).
Results: 1) Interaction between pain and COPD: pain is a common experience in COPD, heightened by breathlessness and anxiety. 2) Pain interfering with PR: a) Communicating pain: HCPs rarely ask about pain and patients are reluctant to report it for fear of being removed from PR. b) PR is a short-term aggravator but long-term reliever: although pain limits exercise, concentration, and program adherence, PR may reduce pain by increasing muscle strength and improving coping. c) Advice and strategies for pain: some attention is given to pain management but this is often counterproductive, encouraging patients to cease exercise. 3) An intervention to manage pain: HCPs were enthusiastic about delivering a pain intervention within their knowledge and time constraints. Early group education was preferred.
Conclusion: A pain intervention seems warranted in PR and may improve adherence and therefore clinical benefit. A pain intervention could be provided as part of PR education with HCP training.

Keywords: COPD, pain, qualitative, health care professions, education, pulmonary rehabilitation

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