Only 5 patients (20%) used evidence-based treatments to manage all of their chronic pain conditions; all 5 had back pain, and 1 also had osteoarthritic pain.  Seven others (28%) did not use any available evidence-based treatments to treat back pain, headache, and/or fibromyalgia. An additional 9 patients (36%) had chronic pain conditions without clear evidence-based alternative pain treatment.

Five of 11 patients (45.5%) with chronic back pain reported using stretching exercises and walking, but none used massage, progressive relaxation, or yoga. Of the 6 patients with osteoarthritis, 2 (33.3%) reported walking and 5 (83.3%) used heat. None of the 4 patients with fibromyalgia reported use of meditative movement therapies, such as tai chi or yoga, and neither of the 2 with headache reported use of biofeedback.


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Use of alternative evidence-based treatments for chronic pain was significantly correlated with male gender (P < .003). Five of 11 men (45.5%) used evidence-based treatments specific to all of their chronic pain conditions, such as walking and/or heat for back and/or osteoarthritis pain. Of 14 women, 8  (57.1%) did not use evidence-based treatments available for their pain syndrome.

No additional correlations were found between age, gender, education, or New York Heart Association (NYHA) status.

The study authors urge caution in interpreting these results because the small sample size amplifies effects. However, the paucity of heart failure patients using alternative chronic pain treatments highlights educational needs in this population.

According to Dr. McDonald, the findings also suggest a need for additional research — possibly a national survey of people with heart failure and comorbid chronic pain — to better determine the safety and efficacy of pain treatments currently used, and identify other ways to reduce pain and enhance cardiac outcomes.

More Research Needed

Sarah Goodlin, MD, chief of geriatrics at the Veterans Administration Medical Center in Portland, Oregon, and president of the Patient-Centered Education and Research Institute, has focused much of her research on outpatient studies. She says the findings of this inpatient study are not inconsistent with her findings.

“We found a high percentage of people using medications that might make their heart failure worse. I think about 15% of the patients in our study were using NSAIDs, which are contraindicated in moderate to advanced heart failure. We also found that one in 8 patients were using gabapentin, which often causes fluid retention and edema,” Dr. Goodlin said.