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.
Causes of Pain with COPD
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.
Treatment for Chronic Pain with COPD
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.
So What Should I Do?
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.