Co-occurrence of pain and dyspnea in Veterans with COPD: Relationship to functional status and a pilot study of neural correlates using structural and functional magnetic resonance imaging.

Autor:	Moy ML; Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America.; Harvard Medical School, Boston, MA, United States of America., Daniel RA; Boston University School of Medicine, Boston, MA, United States of America., Cruz Rivera PN; Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America., Mongiardo MA; Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America., Goldstein RL; Pulmonary, Critical Care, and Sleep Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America., Higgins DM; Boston University School of Medicine, Boston, MA, United States of America.; Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, MA, United States of America., Salat DH; Harvard Medical School, Boston, MA, United States of America.; Neuroimaging Research for Veterans Center, VA Boston Healthcare System, Boston, MA, United States of America.; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States of America.
Jazyk:	angličtina
Zdroj:	PloS one [PLoS One] 2021 Jul 15; Vol. 16 (7), pp. e0254653. Date of Electronic Publication: 2021 Jul 15 (Print Publication: 2021).
DOI:	10.1371/journal.pone.0254653
Abstrakt:	Persons with COPD experience co-occurring dyspnea and pain. Little is known about the relationship between symptom co-occurrence with physical activity (PA) and exercise. Novel diagnostic tools are needed for accurate symptom discrimination. In this secondary analysis, we examined relationships between baseline assessments of pain, dyspnea, objectively measured PA, and exercise capacity in persons with COPD who previously enrolled in three PA studies. Pain was assessed with the bodily pain domain of the Veterans RAND-36 (VR-36), and dyspnea with the modified Medical Research Council (mMRC) scale. Average daily step count was assessed with the Omron HJ-720ITC or FitBit Zip pedometer, and exercise capacity with 6-minute walk test (6MWT). We also conducted a pilot neuroimaging study. Neuroimaging data were acquired on a Siemens 3-Tesla Magnetom Prismafit whole-body scanner. Analysis of variance assessed trends in daily step count and 6MWT distance across categories of co-occurring pain and dyspnea. General linear models examined relationships between cortical thickness and resting state functional connectivity (fc) with symptoms and functional status. In 373 Veterans, 98% were male with mean age 70.5± 8.3 years and FEV1% predicted 59 ± 21%. Compared to those with no co-occurrence of pain and dyspnea, those with co-occurrence walked 1,291-1,444 fewer steps per day and had an 80-85 m lower 6MWT distance. Ten males participated in the pilot neuroimaging study. Predominant findings were that lower cortical thickness and greater fc were associated with higher pain and dyspnea, p<0.05. Greater cortical thickness and lower fc were associated with higher daily step count and 6MWT distance, p<0.05. Regional patterns of associations differed for pain and dyspnea, suggesting that cortical thickness and fc may discriminate symptoms. Co-occurring dyspnea and pain in COPD are associated with significant reductions in PA and exercise capacity. It may be feasible for neuroimaging markers to discriminate between pain and dyspnea. Competing Interests: The authors have declared that no competing interests exist.
Databáze:	MEDLINE
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