Living with Chronic Pain

Do you ever get pain that you think could be related to COPD? For example, you may get pain from chest tightness, rib cramps, skin tears, or something else? Do you feel like pain is a common symptom associated with COPD, or do you think most people don't know about it? We've had some community members express that there IS pain related to COPD. Coughing and wheezing can be painful - but many people don't know that unless they have COPD. Why? Because COPD is invisible, and so is pain. Join us this month as we raise awareness about the connection between COPD and pain: discuss in the forums, share your story, read about it - whatever you choose! [poll nexus_id="1933"] Do you want to share your COPD and pain story? Submit a Story Tweet us. Tweet Us Join the conversation in our Spotlight forum. Share in the Forum Related articles See how other members of the community talk about pain. Extreme Pain in Rib Cage By Yfrenchie It started long before I found out I have COPD, I couldn’t figure out what was causing this pain inside my rib cage because many or no activities would bring it on... READ MORE Pain in the Rib Cage By egarner I wanted to post something about these muscle spasms. I also had these for quite some time and they were quite painful...READ MORE [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Pain can be classified as an “invisible” symptom. Unlike a broken arm in a cast or a bleeding wound, pain cannot be immediately seen. Because of this, it’s possible for an individual to live their life day-to-day in severe pain, without anyone else realizing it. Pain and Stigma Pain is a symptom that can carry along with it a fair amount of stigma. This leads some individuals to not want to disclose that they are in pain at all. Since others cannot visibly judge an individual’s pain level just by looking at them, pain can often be misunderstood. These misunderstandings may lead to a variety of stereotypes or perceptions being cast onto someone who is battling chronic pain. These judgments can come from friends, family members, employers, or even healthcare providers.1,2 What does stigma look like? In some cases, the stigma around chronic pain may take the form of being labeled as weak or as a complainer. In other cases, a judgment may be made that someone in pain is lying about how bad their pain really is to get attention or time off from work. Sometimes, especially in our current opioid-crisis era, this stigma may come in the form of being labeled as a drug-seeker who is in little or no pain at all, and just wants to fuel an addiction. In many instances, there can be multiple layers of stigma happening all at once.1,2 Navigating this lack of belief and support can be challenging and isolating for those with chronic pain. [native] Coping with an invisible ailment Coping with an invisible ailment and the stigma that often accompanies it can be a long-term and difficult process. Management of invisible symptoms or conditions, including chronic pain, may be improved by some of the following: Finding those who provide positive support: Although there are some individuals who purposefully judge someone that says they are in pain, there are many others who don’t. It may be a challenge to determine who the unconditional supporters in your life are, however, they are out there. If you are finding that no one in your environment is providing you with the support you need and deserve, consider finding a support group in your area (or online) with others who are in a similar situation as you. Being surrounded by others who understand first-hand what you’re going through may provide the boost you need to keep moving forward. Trusting your body and mind: Don’t forget that the pain you are feeling and perceiving is valid. If your body and mind are telling you that something is wrong or that you are in pain, trust them. Even if others question if what you’re feeling is really present or as serious as you think it is, trust yourself and your personal experiences. You know your body best, and what it’s telling you. Participating in things that make you happy: Stigma and pain can both take their toll on mental, emotional, and physical health.3 Finding hobbies or activities that bring you joy may help ward off the negative impacts of life with chronic pain. Activities do not have to be strenuous or physical, and can instead be watching a favorite movie or playing a game. Partnering with the right healthcare provider: At some point during your battle with chronic pain, you may find yourself in the care of a professional who is not providing you with the support and consideration you deserve. If you feel as though you have a provider who doesn’t make you or your experiences feel valued, it may be a good idea to get a second opinion or a new provider, if possible. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"] Pain management is an important part of treatment for chronic obstructive pulmonary disease (COPD), yet so often, the medical support system may overlook pain as an element of COPD. As we all know, COPD is a disease of the lungs. Although COPD doesn’t cause lung pain per se, it can cause chest pain due to factors such as coughing. Pain management strategies may be of benefit since both the struggle to breathe and the emotional anxiety of having COPD is of concern to a large number of people with COPD. A study from 2015, published in the medical journal Chest, found that 66 percent of people with COPD reported moderate to severe pain. What causes pain in COPD patients? There are direct as well as indirect reasons as to why pain may occur with COPD. With COPD, the lungs can be hyperinflated due to the obstructive nature of the disease. This overinflation can cause pressure on the chest wall, the spine, and the diaphragm. The pain can be real and severe, and it can be aggravated by something as simple as just walking. Another common cause of pain in COPD is osteoporosis, a severe loss of density in the bones. Osteoporosis may affect up to 20 percent of people with COPD. Osteoporosis can be due to COPD inflammation, use of systemic steroid medication as part of a treatment regimen, a history of smoking, poor nutrition, and also inactivity. Osteoporosis is a common cause of pain in COPD due to bone fractures and bone pain. Osteoporosis can also increase the risk for back pain from hyperinflated lungs. Vigorous and uncontrolled coughing spasms may cause strains in the chest muscles or even lead to a broken rib, especially if osteoporosis is present. Additionally, anxiety, which is often associated with the stress of struggling to breathe, may cause a person's pain threshold to decrease and pain sensitivity to increase. Treating chronic COPD pain According to research, analgesic pain relievers are the most commonly used treatment for pain in COPD. Analgesics target a broad range of pain, from mild to severe, and include: Non Steroidal Anti-inflammatory Drugs (NSAIDs) - These can include Ibuprofen (e.g. Motrin), Naproxen (e.g. Aleve) and acetylsalicylic acid (e.g. Aspirin) Opioids - These can include morphine and codeine Non-Pharmacologic Methods of Pain Control Of course, the issue with analgesic medications is that some of them, like morphine and codeine, can be addicting. Besides that, taking too many of them, either all at once or over an extended period of time, can depress the respiratory center (in the brain) which may compromise breathing further. With non-pharmacological methods of pain relief, there is no need to worry about addiction or respiratory depression. Some methods of pain control (without medication[s]) include: Pulmonary rehabilitation: This is the best treatment for chest and muscle pain. Pulmonary rehab strengthens the muscles of the chest wall and reduces pain. This approach includes physical therapy, breathing retraining, and emotional support. It can decrease anxiety as well as improve strength and endurance. Ice: can be used to reduce swelling and inflammation associated with chronic pain. Heat: increases blood flow to the tissues; this works great for arthritis-type pain. Massage: can help relax stiff joints and muscles, which in turn, provides pain relief. Physical therapy: (as mentioned in pulmonary rehab) provides pain relieving modalities such as ultrasound and electrical nerve stimulation while teaching more efficient ways to move and better cope with the pain. This may be suitable if no pulmonary rehabilitation program is available in one's geographical location. Staying Active: In the absence of pulmonary rehabilitation or even physical therapy, devising one's own personal approach, in conjunction with a physician, can help to control one's pain. Acupuncture: some believe this approach alleviates the pain associated with COPD. This should be discussed with a physician first. Focusing on pain management The relationship between COPD and pain is being increasingly recognized, although research is ongoing as to how to best manage the two conditions together. Not all physicians are as well versed in treating both conditions as we might like to see. Pain management for COPD depends on what is causing the pain and how advanced COPD is. One may benefit from pain management strategies because of both the struggle to breathe and the emotional anxiety of having COPD. If you have COPD and are having significant pain, talk with your doctor about it. If you are struggling emotionally with pain, be sure to ask for help. Work closely with your physician to find the cause of your pain and the best treatment options for you. [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site" title="Sign up for emails from {{site-name}}:"],Chest tightness is a common symptom of chronic obstructive pulmonary disease (COPD). The sensation of a tight chest may feel different for different people. Chest tightness may feel like:1 It is hard to take a deep breath. It is painful to breathe. Something is wrapped around or sitting on the chest. Chest tightness is often accompanied by wheezing or feeling out of breath. Wheezing is a high-pitched whistling sound that happens when a person breathes in or breathes out.2 What can cause chest tightness for people with COPD? Chest tightness can be caused by many things in people with COPD. Causes of chest tightness may include:1,2 Blockage in the airways Air sac damage Bronchospasms Respiratory infection COPD causes lung damage called airway obstruction. In airway obstruction, the airways become blocked. In turn, air cannot travel through the passages and lungs as well as it should. This can be caused by chronic bronchitis, emphysema, or a combination of both.1,2 Chronic bronchitis causes airway obstruction in 2 ways. First, the airways of people with chronic bronchitis are constantly irritated and inflamed. Second, their lungs produce excess amounts of mucus that must be cleared through the airways. The swelling, combined with the extra mucus, causes the airways to become too narrow. This can cause a feeling of chest tightness.1,2 Emphysema causes damage to the millions of tiny air sacs in the lungs where oxygen is absorbed into the body. This can lead to a feeling of chest tightness. The damage to the air sacs can cause air to get trapped in the lungs. This makes it harder to fully breathe all the air out. This can cause a tight feeling in the chest, especially during physical activity or exercise.1,2 People with COPD can also have bronchospasms. A bronchospasm happens when the muscles surrounding the airways suddenly get very tight. When the muscles tighten up, it makes the airways too narrow for enough air to pass through. This can also cause chest tightness.1,2 People with COPD are more likely to get respiratory infections. These infections can also cause chest tightness. Infections that may cause chest pain or tightness include pneumonia, the flu, or acute bronchitis.1,2 Flare-ups and COPD chest tightness Changes in feelings of chest tightness may be a sign of a COPD exacerbation, or flare-up. Respiratory infections are the most common cause of COPD flare-ups. These infections can also cause chest tightness. If you have signs of a flare-up, contact your doctor about the best way to treat the attack.1,3 Chest tightness can also be a sign of serious heart problems such as a heart attack. If your chest tightness feels different than normal, comes on suddenly, or if you are experiencing other symptoms, call your doctor right away. Other symptoms that can be related to a heart problem include:4 Pain that radiates down your left arm or to your back, neck, jaw, or shoulders Cold sweats Nausea or vomiting Dizziness How can chest tightness be treated or managed? Treatment for chest tightness related to COPD depends on the cause of the symptom and how severe the symptom is. If an infection is causing the tightness, treating the infection with steroids and antibiotics is helpful. Because COPD is a lung condition, treatment for non-cardiac chest tightness in COPD includes bronchodilators to open the airways.1 Other things that can help prevent or treat chest tightness include:1 Avoiding irritants like smoke or pollution Staying up-to-date on flu and pneumonia vaccines Breathing techniques Staying active as much as is safe and possible [lead_gen showIfLoggedIn="0" campaign="shortcode" source="site"] While COPD isn’t necessarily a painful disease, there is some good evidence linking COPD to pain. Here are 8 things to know about COPD-related pain. Many people in the COPD community report pain If you suffer from chronic pain and COPD, you are not alone. Various studies appear to show that the prevalence of pain reported among the COPD community ranges between 45% and 94%, and the prevalence of pain among those with severe COPD ranges between 21% and 77%.1,2 Overall, studies seem to show that patients with COPD were more likely to report chronic pain, chronic pain medicine use, and chronic opioid use compared to people with other chronic diseases.3-5 There are many different types of COPD-related pain It could be general aches and pains, headaches, and even chest pain. In one 2016 study of 67 COPD patients, 82.1% reported pain, while 53.7% reported chest pain. So, chest pain appears to be rather common.1 Pain can impact quality of life An interesting theory is that pain makes it difficult to sleep, and this may lead to anxiety and depression. Pain may also make it difficult to stay active, and this results in muscle weakness. The combination of these effects may result in fatigue and an increased feeling of shortness of breath. So pain, especially severe pain, may reduce the overall quality of life. Researchers are not sure whether pain treatment will improve quality of life, or if treating COPD will reduce pain.2,5 The cause of COPD pain is difficult to determine There are some pretty good theories out there. For instance, accessory muscles are muscles that are used to assist your normal muscles of inspiration. They are not meant to be used every day. So, chronic use of these muscles may cause them to become sore. Muscles may also become sore from coughing. In the 2016 study mentioned above, the researchers hypothesized that increased chest pain would correlate with increased loss of lung function, but this proved not to be true.1 Headaches may be due to sinusitis or anxiety. Osteoporosis is also common among the COPD community, so this might cause arm, leg, hip, or even back pain. People with COPD appear to be under-treated for pain In the same study of the 67 COPD patients referred to above, despite 82.1% reporting pain, only 39% reported that they were taking pain medicine. One theory here is that COPD patients may stay silent about their symptoms, including pain, because they simply learn to tolerate it, or because they believe there is nothing that can be done about it. So, this spotlights a potential concern for the COPD community.1 COPD-related pain is treatable Pain medicines often used to treat COPD-related pain include acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). Generic options of these over the counter medicines are also available at a reduced cost. More severe pain can be treated with prescription pain medicines if necessary. This is not to say that pain medicine is the only solution for pain. Many experts agree that pulmonary rehabilitation, exercise, and staying active improve your overall physical well-being and reduce the feeling of shortness of breath, thereby reducing COPD-related pain. Diagnosing and treating the underlying cause of the pain may also help. For instance, sinusitis is sometimes associated with headaches and anxiety with chest pain. So, diagnosing and treating these conditions, when they are present, may also reduce pain. COPD-related pain is barely recognized in COPD guidelines This might further spotlight the lack of respect for pain among the COPD population. Some researchers have mentioned the need to update guidelines with better assessment tools for helping physicians better identify and properly treat COPD patients also suffering from pain. So, these are just a few updates we might see to future COPD guidelines to help people live better with COPD.1-2, 5 Researchers are striving to learn more about COPD related pain Some researchers believe that COPD-related pain is underdiagnosed because so little is known about what causes it.1 Sure there are theories as noted above, but there may be something, perhaps something simple, that is being overlooked. To learn more about links between pain and COPD, further studies are ongoing. Ideally, this research will provide wisdom needed to help physicians help their patients live better and longer with COPD. Again, COPD is not generally considered a painful disease, although it may be associated with pain, even chronic pain. If you suffer from pain, even pain that is mild and tolerable, make sure to talk to your physician about this. There may be a simple solution that allows you to live better with COPD. 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Living with Chronic Pain

COPD and Pain? It Does Exist!

The Invisibility of Pain

Tips for Managing COPD Pain

Chest Tightness

8 Things To Know About COPD Pain

Expert Answers: Pain Relief with COPD

Community Feedback: Rib Cramping with COPD

The Stigma Around Pain and Medications