THE RELATIONSHIP OF NAUSEA AND DYSPNEA TO PAIN IN SERIOUSLY ILL PATIENTS

Objective: To describe the hospital symptom experience of seriously il l patients with common illnesses. To assess the independent associatio n of nausea and dyspnea to level of pain. Design: Cross-sectional stud y. Setting: Five tertiary care academic centers in the US. Participant s: 1556 patients admitted between June 1989 and June 1991 in SUPPORT ( Study to Understand Prognoses and Preferences for Outcomes and Risks o f Treatments) who answered questions concerning frequency and severity of pain, nausea and dyspnea, and the depression and anxiety subscales of the Profile of Mood States. Methods: Seriously ill patients were i nterviewed a median of 8 days after hospitalization concerning the fre quency and severity of their pain, nausea and dyspnea. Frequencies of symptoms and symptom combinations were tabulated. Ordinal logistic reg ression was used to test the independent association of level of pain with nausea and dyspnea. The analysis was adjusted for 22 additional d emographic, psychological, chronic and acute illness measures. Results : At least some level of anxious mood was reported by 85.2% of patient s, depressed mood by 72.3% of patients, pain by 51.2% of patients, dys pnea by 48.6% of patients and nausea by 23.9% of patients. At least so me degree of one of the five symptoms was reported by 94.2% of patient s. Multivariable analysis controlling for demographic, psychological, and chronic and acute illness variables revealed that nausea and dyspn ea were independently related to level of pain. Compared to patients w ithout these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4) and very severe (level 5) nausea had adds ratios (OR) for higher levels of pain of 1.62 (1.24, 2.12) (95% c onfidence interval), 2.36 (1.39, 4.00), 2.57 (1.29, 5.12) and 2.22 (1. 08, 4.53), respectively. Compared to patients without these symptoms, patients who reported mild (level 2), moderate (level 3), more severe (level 4); and very severe (level 5) dyspnea had odds ratios (OR) for higher levels of pain of 1.49 (1.17, 1.90), 1.92 (1.21, 3.04), 2.53 (1 .83, 4.07) and 1.95 (1.39, 2.73), respectively. Conclusions: Seriously ill patients have a high symptom burden. Patients who have nausea and dyspnea experience more pain than patients without these symptoms, ev en after adjustment for depression, anxiety, disease type, disease sev erity and demographic and psychological measures. The causal associati on between these symptoms and pain remains to be determined. Though pa in may cause dyspnea and nausea, the intriguing possibility remains th at, in addition to relieving suffering, treating dyspnea and nausea ma y relieve pain. (C) 1997 International Association for the Study of Pa in.