Aligning Recommendations for Pain Management in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review of Clinical Practice Guidelines

Objective(s): To update the evidence on pain management, to determine alignment of pain management recommendations with best-practice, and to advocate for optimal pain management in patients with COPD.

Data Sources: PubMed, Guideline International Network, Guideline Portal, Agency for Healthcare Research and Quality, National Institute for Healthcare Excellence, Scottish International Guidelines Network, and Institute of Medicine. Grey literature, national websites, and bibliographies were also searched.

Study Selection: Inclusion criteria: CPGs available online for stable COPD using techniques within the scope of practice of United States physical therapists as defined by the American Physical Therapy Association. CPGs produced by an organization/organizations representing reputable knowledge of COPD management. Exclusion criteria: CPGs unavailable online, not translatable into English, or not including techniques within the defined scope of practice.

Data Extraction: Researchers performed frequency counts for the verbatim terms “pain,” “physical activity,” “exercise,” “rehabilitation,” “physical therap(ist)/(y), ”physiotherap(ist)/(y),” recorded context for each occurrence, and collected recommendations for pain management/treatment when present.

Data Synthesis: Of 32 CPGs, 24 included “pain" verbatim. Of these, 13 included recommendations for pain treatment/management. Common recommendations included opioids, pharmacological management, further medical assessment, and surgical intervention. Two CPGs recommended referral to palliative care, one CPG discussed treating cough, and one discussed massage, relaxation, and breathing techniques.

Conclusions: Pain management recommendations vary and are not aligned with evidence. Pain should be addressed in patients with COPD, whether directly or indirectly related to the disease. Reduction of variability in pain management and the disease burden n is necessary. Pain management should include referrals to providers who can maximize benefit of their services.

Author(s) Disclosures: A grant from APTA Cardiovascular and Pulmonary supported this work.