Developing and testing a new theoretical model of pain in heart failure

Abstract

Introduction: An estimated 23-85% of adults with chronic heart failure (HF) experience comorbid chronic pain, yet no comprehensive theoretical models have been developed or tested that completely capture the salient variables which affect pain. The aim of this study was to construct a preliminary theoretical model of pain in HF and evaluate the associations between identified variables in the model with pain presence. Methods: In this cross-sectional study, baseline data were obtained from the Cognitive Intervention to Improve Memory in Heart Failure Patients study (MEMOIR-HF) (n = 235). The Biopsychosocial Model of Chronic Pain was adapted for an HF-specific population. The dependent variable was pain presence (yes/no), which was measured using the Health Utilities Index Mark-3 (HUI-3). Independent variables were identified for the model using previous literature and univariate analyses comparing patients with vs. without pain in MEMOIR-HF. Logistic regression was used to test for differences between patients with pain present and not present. Results: Demographics were 45.5% men, 54.5% women, 86.4% White, 13.6% Black, mean age 66.39 (SD 12.04) years. Of 235 patients, 159 (67.66%) reported pain on the HUI-3 items. The variables that were included following univariate analysis and literature review were age, self-reported race and gender, comorbid conditions, sleep disturbances, HF severity, B-type natriuretic peptide, brain-derived neurotrophic factor, body mass index, and depression. Patients with pain were more likely to have worse HF severity (NYHA Class II or III compared with Class I) (Class II: OR 5.09 [1.71 – 15.08], p = .003, Class III: 5.05 [1.73 – 14.71], p = .003), more severe depression (OR 1.14 [1.06 – 1.23], p = .001), and worsened daytime sleepiness (OR 0.90 [0.83 – 0.98], p = .017), see Table 1. Conclusions: We believe this study is one of the first to construct and test a preliminary comprehensive model of pain in HF. Complete characterization of pain in HF is needed before treatments can be improved. Future research is needed to explore variables that were not available in the MEMOIR-HF dataset. More robust pain measures are needed to adequately test all variables.