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Prevalence of musculoskeletal pain and its impact on quality of life and functional exercise capacity in patients with pulmonary arterial hypertension

Published:February 02, 2022DOI:https://doi.org/10.1016/j.rmed.2022.106759

      Highlights

      • 77% of PAH patients experience musculoskeletal pain.
      • PAH drugs seem to increase musculoskeletal pain prevalence.
      • Pain prevalence is highest at low back, followed by knees and neck regions.
      • Knee pain has the strongest impact on quality of life and functional status.
      • Examining and addressing musculoskeletal pain complaints may improve PAH management.

      Abstract

      Background

      In pulmonary arterial hypertension (PAH), pathophysiological consequences of the disease and the drugs used to treat PAH may adversely affect musculoskeletal system. Aim of the study was to evaluate musculoskeletal pain prevalence and its impact on quality of life (QoL) and exercise capacity in PAH patients.

      Methods

      61 PAH patients were evaluated with Nordic Musculoskeletal Questionnaire (NMQ) for musculoskeletal pain presence, EmPHasis-10 and Minnesota Living with Heart Failure Questionnaire (MLHFQ) for QoL, 6-min walk test (6MWT) for functional exercise capacity and International Physical Activity Questionnaire- Short Form (IPAQ-SF) for physical activity participation.

      Results

      77% of PAH patients reported musculoskeletal pain. Pain prevalence was highest at low back (38%), followed by knees (36%), shoulders (36%) and neck (33%). Hemodynamic indicators of PAH severity were associated with pain presence in various parts of the body. Patients receiving any PAH-specific drug were more likely to experience pain compared to the patients whose drug therapy has not yet been initiated (RR = 1.6–2.0). Pain presence in neck, shoulder, low back and knees significantly correlated to worse QoL scores in both EmPHasis-10 and MLHFQ (p < 0.05). Pain presence in knees had the strongest influence on QoL, and it was the only significant correlate of 6MWT (r = −0.424) and IPAQ-SF (r = −0.264) (p < 0.05).

      Conclusions

      Musculoskeletal pain is a common complaint in PAH patients, which significantly impairs QoL and physical functioning. Treatment strategies should include a more comprehensive assessment for musculoskeletal pain complaints of these patients and address pain presence accordingly, which may help providing a better management for PAH.

      Keywords

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      References

        • Simonneau G.
        • Montani D.
        • Celermajer D.S.
        • Denton C.P.
        • Gatzoulis M.A.
        • Krowka M.
        • Williams P.G.
        • Souza R.
        Haemodynamic definitions and updated clinical classification of pulmonary hypertension.
        Eur. Respir. J. 2019; 53: 1801913
        • Galie N.
        • Humbert M.
        • Vachiery J.L.
        • Gibbs S.
        • Lang I.
        • Torbicki A.
        • Simonneau G.
        • Peacock A.
        • Vonk Noordegraaf A.
        • Beghetti M.
        2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the European society of Cardiology (ESC) and the European respiratory society (ERS): endorsed by: association for European paediatric and congenital Cardiology (AEPC), international society for heart and lung transplantation (ISHLT).
        Eur. Respir. J. 2015; 46: 903-975
        • Babu A.S.
        • Arena R.
        • Myers J.
        • Padmakumar R.
        • Maiya A.G.
        • Cahalin L.P.
        • Waxman A.B.
        • Lavie C.J.
        Exercise intolerance in pulmonary hypertension: mechanism, evaluation and clinical implications.
        Expet Rev. Respir. Med. 2016; 10: 979-990
        • Reis A.
        • Santos M.
        • Vicente M.
        • Furtado I.
        • Cruz C.
        • Melo A.
        • Carvalho L.
        • Goncalves F.
        • Sa-Couto P.
        • Almeida L.
        Health-related quality of life in pulmonary hypertension and its clinical correlates: a cross-sectional study.
        BioMed Res. Int. 2018; 2018: 3924517
        • Grunig E.
        • Eichstaedt C.
        • Barbera J.A.
        • Benjamin N.
        • Blanco I.
        • Bossone E.
        • Cittadini A.
        • Coghlan G.
        • Corris P.
        • D'Alto M.
        ERS statement on exercise training and rehabilitation in patients with severe chronic pulmonary hypertension.
        Eur. Respir. J. 2019; 53
        • Manders E.
        • Rain S.
        • Bogaard H.J.
        • Handoko M.L.
        • Stienen G.J.
        • Vonk-Noordegraaf A.
        • Ottenheijm C.A.
        • de Man F.S.
        The striated muscles in pulmonary arterial hypertension: adaptations beyond the right ventricle.
        Eur. Respir. J. 2015; 46: 832-842
        • Panagiotou M.
        • Peacock A.J.
        • Johnson M.K.
        Respiratory and limb muscle dysfunction in pulmonary arterial hypertension: a role for exercise training?.
        Pulm. Circ. 2015; 5: 424-434
        • Wei A.
        • Gu Z.
        • Li J.
        • Liu X.
        • Wu X.
        • Han Y.
        • Pu J.
        Clinical adverse effects of endothelin receptor antagonists: insights from the meta-analysis of 4894 patients from 24 randomized double-blind placebo-controlled clinical trials.
        J. Am. Heart Assoc. 2016; 5
        • Barnes H.
        • Brown Z.
        • Burns A.
        • Williams T.
        Phosphodiesterase 5 inhibitors for pulmonary hypertension.
        Cochrane Database Syst. Rev. 2019; 1: CD012621
        • Kingman M.
        • Archer-Chicko C.
        • Bartlett M.
        • Beckmann J.
        • Hohsfield R.
        • Lombardi S.
        Management of prostacyclin side effects in adult patients with pulmonary arterial hypertension.
        Pulm. Circ. 2017; 7: 598-608
        • Garnaes K.K.
        • Morkved S.
        • Salvesen O.
        • Tonne T.
        • Furan L.
        • Gronhaug G.
        • Vasseljen O.
        • Johannessen H.H.
        What factors are associated with health-related quality of life among patients with chronic musculoskeletal pain? A cross-sectional study in primary health care.
        BMC Muscoskel. Disord. 2021; 22: 102
        • Kuorinka I.
        • Jonsson B.
        • Kilbom A.
        • Vinterberg H.
        • Biering-Sorensen F.
        • Andersson G.
        • Jorgensen K.
        Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms.
        Appl. Ergon. 1987; 18: 233-237
        • Kahraman T.
        • Genc A.
        • Goz E.
        The Nordic Musculoskeletal Questionnaire: cross-cultural adaptation into Turkish assessing its psychometric properties.
        Disabil. Rehabil. 2016; 38: 2153-2160
        • Yorke J.
        • Corris P.
        • Gaine S.
        • Gibbs J.S.
        • Kiely D.G.
        • Harries C.
        • Pollock V.
        • Armstrong I.
        emPHasis-10: development of a health-related quality of life measure in pulmonary hypertension.
        Eur. Respir. J. 2014; 43: 1106-1113
        • Odevoglu P.
        • Demir R.
        • Okumus G.
        • Kucukoglu M.S.
        • Kuran Aslan G.
        Validity and reliability of the Turkish version of the EmPHasis-10 questionnaire in patients with pulmonary hypertension.
        J. Eval. Clin. Pract. 2019; 25: 896-902
        • Cenedese E.
        • Speich R.
        • Dorschner L.
        • Ulrich S.
        • Maggiorini M.
        • Jenni R.
        • Fischler M.
        Measurement of quality of life in pulmonary hypertension and its significance.
        Eur. Respir. J. 2006; 28: 808-815
        • Okutucu S.
        • Sabanov C.
        • Karakulak U.N.
        • Evranos B.
        • Fatihoglu S.G.
        • Sahiner L.
        • Kaya E.B.
        • Aytemir K.
        • Kabakci G.
        • Tokgozoglu L.
        OP-174: validation of the Turkish version of the Minnesota living with heart failure questionnaire.
        Int. J. Cardiol. 2011; 147: S74
        • Holland A.E.
        • Spruit M.A.
        • Troosters T.
        • Puhan M.A.
        • Pepin V.
        • Saey D.
        • McCormack M.C.
        • Carlin B.W.
        • Sciurba F.C.
        • Pitta F.
        • Wanger J.
        • MacIntyre N.
        • Kaminsky D.A.
        • Culver B.H.
        • Revill S.M.
        • Hernandes N.A.
        • Andrianopoulos V.
        • Camillo C.A.
        • Mitchell K.E.
        • Lee A.L.
        • Hill C.J.
        • Singh S.J.
        An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease.
        Eur. Respir. J. 2014; 44: 1428-1446
        • Demir R.
        • Kucukoglu M.S.
        Six-minute walk test in pulmonary arterial hypertension.
        Anatol. J. Cardiol. 2015; 15: 249-254
        • Craig C.L.
        • Marshall A.L.
        • Sjostrom M.
        • Bauman A.E.
        • Booth M.L.
        • Ainsworth B.E.
        • Pratt M.
        • Ekelund U.
        • Yngve A.
        • Sallis J.F.
        • Oja P.
        International physical activity questionnaire: 12-country reliability and validity.
        Med. Sci. Sports Exerc. 2003; 35: 1381-1395
        • Saglam M.
        • Arikan H.
        • Savci S.
        • Inal-Ince D.
        • Bosnak-Guclu M.
        • Karabulut E.
        • Tokgozoglu L.
        International physical activity questionnaire: reliability and validity of the Turkish version.
        Percept. Mot. Skills. 2010; 111: 278-284
        • Vartiainen P.
        • Heiskanen T.
        • Sintonen H.
        • Roine R.P.
        • Kalso E.
        Health-related quality of life and burden of disease in chronic pain measured with the 15D instrument.
        Pain. 2016; 157: 2269-2276
        • Algina J.
        • Olejnik S.
        Sample size tables for correlation analysis with applications in partial correlation and multiple regression analysis.
        Multivariate Behav. Res. 2003; 38: 309-323
        • Sarzynska K.
        • Swiatoniowska-Lonc N.
        • Dudek K.
        • Jonas K.
        • Kopec G.
        • Gajek J.
        • Jankowska-Polanska B.
        Quality of life of patients with pulmonary arterial hypertension: a meta-analysis.
        Eur. Rev. Med. Pharmacol. Sci. 2021; 25: 4983-4998
        • Batt J.
        • Ahmed S.S.
        • Correa J.
        • Bain A.
        • Granton J.
        Skeletal muscle dysfunction in idiopathic pulmonary arterial hypertension.
        Am. J. Respir. Cell Mol. Biol. 2014; 50: 74-86
        • Mense S.
        Muscle pain: mechanisms and clinical significance.
        Dtsch Arztebl Int. 2008; 105: 214-219
        • Price L.C.
        • Wort S.J.
        • Perros F.
        • Dorfmuller P.
        • Huertas A.
        • Montani D.
        • Cohen-Kaminsky S.
        • Humbert M.
        Inflammation in pulmonary arterial hypertension.
        Chest. 2012; 141: 210-221
        • Ryan J.J.
        • Huston J.
        • Kutty S.
        • Hatton N.D.
        • Bowman L.
        • Tian L.
        • Herr J.E.
        • Johri A.M.
        • Archer S.L.
        Right ventricular adaptation and failure in pulmonary arterial hypertension.
        Can. J. Cardiol. 2015; 31: 391-406
        • Vos T.
        • Flaxman A.D.
        • Naghavi M.
        • Lozano R.
        • Michaud C.
        • Ezzati M.
        • Shibuya K.
        • Salomon J.A.
        • Abdalla S.
        • Aboyans V.
        Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.
        Lancet. 2012; 380: 2163-2196
        • Breivik H.
        • Collett B.
        • Ventafridda V.
        • Cohen R.
        • Gallacher D.
        Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment.
        Eur. J. Pain. 2006; 10: 287-333
        • Fayaz A.
        • Croft P.
        • Langford R.M.
        • Donaldson L.J.
        • Jones G.T.
        Prevalence of chronic pain in the UK: a systematic review and meta-analysis of population studies.
        BMJ Open. 2016; 6e010364
        • Bischoff E.
        Potency, selectivity, and consequences of nonselectivity of PDE inhibition.
        Int. J. Impot. Res. 2004; 16: S11-S14
        • Yorke J.
        • Deaton C.
        • Campbell M.
        • McGowen L.
        • Sephton P.
        • Kiely D.G.
        • Armstrong I.
        Symptom severity and its effect on health-related quality of life over time in patients with pulmonary hypertension: a multisite longitudinal cohort study.
        BMJ Open Respir Res. 2018; 5e000263
        • Lee A.L.
        • Goldstein R.S.
        • Brooks D.
        Chronic pain in people with chronic obstructive pulmonary disease: prevalence, clinical and psychological implications.
        Chronic Obstr Pulm Dis. 2017; 4: 194-203
        • Alemzadeh-Ansari M.J.
        • Ansari-Ramandi M.M.
        • Naderi N.
        Chronic pain in chronic heart failure: a review article.
        J Tehran Heart Cent. 2017; 12: 49-56
        • Kim W.
        • Jin Y.S.
        • Lee C.S.
        • Bin S.I.
        • Lee S.Y.
        • Choi K.H.
        Influence of knee pain and low back pain on the quality of life in adults older than 50 Years of age.
        Pharm. Manag. PM R. 2015; 7: 955-961
        • Muraki S.
        • Akune T.
        • Oka H.
        • En-Yo Y.
        • Yoshida M.
        • Saika A.
        • Suzuki T.
        • Yoshida H.
        • Ishibashi H.
        • Tokimura F.
        • Yamamoto S.
        • Nakamura K.
        • Kawaguchi H.
        • Yoshimura N.
        Impact of knee and low back pain on health-related quality of life in Japanese women: the Research on Osteoarthritis against Disability (ROAD).
        Mod. Rheumatol. 2010; 20: 444-451
        • Singer J.
        • Yelin E.H.
        • Katz P.P.
        • Sanchez G.
        • Iribarren C.
        • Eisner M.D.
        • Blanc P.D.
        Respiratory and skeletal muscle strength in chronic obstructive pulmonary disease: impact on exercise capacity and lower extremity function.
        J Cardiopulm Rehabil Prev. 2011; 31: 111-119
        • Harrington D.
        • Anker S.D.
        • Chua T.P.
        • Webb-Peploe K.M.
        • Ponikowski P.P.
        • Poole-Wilson P.A.
        • Coats A.J.
        Skeletal muscle function and its relation to exercise tolerance in chronic heart failure.
        J. Am. Coll. Cardiol. 1997; 30: 1758-1764
        • Ozcan Kahraman B.
        • Ozsoy I.
        • Akdeniz B.
        • Ozpelit E.
        • Sevinc C.
        • Acar S.
        • Savci S.
        Test-retest reliability and validity of the timed up and go test and 30-second sit to stand test in patients with pulmonary hypertension.
        Int. J. Cardiol. 2020; 304: 159-163
        • Balogun S.
        • Scott D.
        • Cicuttini F.
        • Jones G.
        • Aitken D.
        Longitudinal study of the relationship between physical activity and knee pain and functional limitation in community-dwelling older adults.
        Arch. Gerontol. Geriatr. 2020; 90: 104101
        • Muraki S.
        • Akune T.
        • Teraguchi M.
        • Kagotani R.
        • Asai Y.
        • Yoshida M.
        • Tokimura F.
        • Tanaka S.
        • Oka H.
        • Kawaguchi H.
        • Nakamura K.
        • Yoshimura N.
        Quadriceps muscle strength, radiographic knee osteoarthritis and knee pain: the ROAD study.
        BMC Muscoskel. Disord. 2015; 16: 305