OBJECTIVE: To describe the hospital symptom experience of seriously ill patients with common illnesses. To assess the independent association of nausea and dyspnea to level of pain. DESIGN: Cross-sectional study. SETTING: Five tertiary care academic centers in the US. PARTICIPANTS: 1556 patients admitted between June 1989 and June 1991 in SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) who answered questions concerning frequency and severity of pain, nausea and dyspnea, and the depression and anxiety subscales of the Profile of Mood States. METHODS: Seriously ill patients were interviewed a median of 8 days after hospitalization concerning the frequency and severity of their pain, nausea and dyspnea. Frequencies of symptoms and symptom combinations were tabulated. Ordinal logistic regression was used to test the independent association of level of pain with nausea and dyspnea. The analysis was adjusted for 22 additional demographic, psychological, chronic and acute illness measures. RESULTS: At least some level of anxious mood was reported by 85.2% of patients, depressed mood by 72.3% of patients, pain by 51.2% of patients, dyspnea by 48.6% of patients and nausea by 23.9% of patients. At least some degree of one of the five symptoms was reported by 94.2% of patients. Multivariable analysis controlling for demographic, psychological, and chronic and acute illness variables revealed that nausea and dyspnea were independently related to level of pain. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) nausea had odds ratios (OR) for higher levels of pain of 1.62 (1.24, 2.12) (95% confidence interval), 2.36 (1.39, 4.00), 2.57 (1.29, 5.12) and 2.22 (1.08, 4.53), respectively. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) dyspnea had odds ratios (OR) for higher levels of pain of 1.49 (1.17, 1.90), 1.92 (1.21, 3.04), 2.73 (1.83, 4.07) and 1.95 (1.39, 2.73), respectively. CONCLUSIONS: Seriously ill patients have a high symptom burden. Patients who have nausea and dyspnea experience more pain than patients without these symptoms, even after adjustment for depression, anxiety, disease type, disease severity and demographic and psychological measures. The causal association between these symptoms and pain remains to be determined. Though pain may cause dyspnea and nausea, the intriguing possibility remains that, in addition to relieving suffering, treating dyspnea and nausea may relieve pain.
OBJECTIVE: To describe the hospital symptom experience of seriously ill patients with common illnesses. To assess the independent association of nausea and dyspnea to level of pain. DESIGN: Cross-sectional study. SETTING: Five tertiary care academic centers in the US. PARTICIPANTS: 1556 patients admitted between June 1989 and June 1991 in SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments) who answered questions concerning frequency and severity of pain, nausea and dyspnea, and the depression and anxiety subscales of the Profile of Mood States. METHODS: Seriously ill patients were interviewed a median of 8 days after hospitalization concerning the frequency and severity of their pain, nausea and dyspnea. Frequencies of symptoms and symptom combinations were tabulated. Ordinal logistic regression was used to test the independent association of level of pain with nausea and dyspnea. The analysis was adjusted for 22 additional demographic, psychological, chronic and acute illness measures. RESULTS: At least some level of anxious mood was reported by 85.2% of patients, depressed mood by 72.3% of patients, pain by 51.2% of patients, dyspnea by 48.6% of patients and nausea by 23.9% of patients. At least some degree of one of the five symptoms was reported by 94.2% of patients. Multivariable analysis controlling for demographic, psychological, and chronic and acute illness variables revealed that nausea and dyspnea were independently related to level of pain. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) nausea had odds ratios (OR) for higher levels of pain of 1.62 (1.24, 2.12) (95% confidence interval), 2.36 (1.39, 4.00), 2.57 (1.29, 5.12) and 2.22 (1.08, 4.53), respectively. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) dyspnea had odds ratios (OR) for higher levels of pain of 1.49 (1.17, 1.90), 1.92 (1.21, 3.04), 2.73 (1.83, 4.07) and 1.95 (1.39, 2.73), respectively. CONCLUSIONS: Seriously ill patients have a high symptom burden. Patients who have nausea and dyspnea experience more pain than patients without these symptoms, even after adjustment for depression, anxiety, disease type, disease severity and demographic and psychological measures. The causal association between these symptoms and pain remains to be determined. Though pain may cause dyspnea and nausea, the intriguing possibility remains that, in addition to relieving suffering, treating dyspnea and nausea may relieve pain.
Authors: Kathy Baker; Jennifer Barsamian; Danielle Leone; Barbara C Donovan; Donna Williams; Kerry Carnevale; Robert Lansing; Robert Banzett Journal: Am J Nurs Date: 2013-11 Impact factor: 2.220
Authors: Vithusha Ganesh; Liying Zhang; Stephanie Chan; Bo Angela Wan; Leah Drost; May Tsao; Cyril Danjoux; Elizabeth Barnes; Rachel McDonald; Leigha Rowbottom; Pearl Zaki; Ronald Chow; Matthew K Hwang; Carlo DeAngelis; Nicholas Lao; Edward Chow Journal: Support Care Cancer Date: 2017-05-23 Impact factor: 3.603
Authors: Ernest DiNino; Mihaela S Stefan; Aruna Priya; Benjamin Martin; Penelope S Pekow; Peter K Lindenauer Journal: J Pain Symptom Manage Date: 2015-11-24 Impact factor: 3.612
Authors: Robert W Hallowell; Richard Schwartzstein; Carl R O'Donnell; Andrew Sheridan; Robert B Banzett Journal: Lung Date: 2019-11-15 Impact factor: 2.584
Authors: Mark B Parshall; Richard M Schwartzstein; Lewis Adams; Robert B Banzett; Harold L Manning; Jean Bourbeau; Peter M Calverley; Audrey G Gift; Andrew Harver; Suzanne C Lareau; Donald A Mahler; Paula M Meek; Denis E O'Donnell Journal: Am J Respir Crit Care Med Date: 2012-02-15 Impact factor: 21.405
Authors: Camilla Zimmermann; Dora Yuen; Ashley Mischitelle; Mark D Minden; Joseph M Brandwein; Aaron Schimmer; Lucia Gagliese; Christopher Lo; Anne Rydall; Gary Rodin Journal: Leuk Res Date: 2013-03-11 Impact factor: 3.156
Authors: Jennifer P Stevens; Tenzin Dechen; Richard Schwartzstein; Carl O'Donnell; Kathy Baker; Michael D Howell; Robert B Banzett Journal: J Pain Symptom Manage Date: 2018-02-22 Impact factor: 3.612