Key result
Patients with acute coronary syndrome reported mild cardiac pain intensity and described their pain using a complex mixture of both nociceptive and neuropathic pain qualities.
Observational (n=121)
No
Patients with acute coronary syndromes experience a complex mixture of nociceptive and neuropathic pain qualities, highlighting the need for comprehensive pain assessment beyond simple one-dimensional numeric rating scales.
May support comprehensive ACS pain assessment beyond intensity scales; leaves open whether mixed qualities alter management or outcomes.
Background: Cardiac pain arising from acute coronary syndrome (ACS) is a multi-factorial phenomenon. Historically, episodes of cardiac pain have been captured using a one-dimensional numeric pain rating scale. Lacking in clinical practice are acute pain assessments that employ a comprehensive evaluation of an emergent ACS episode. Aim: To examine the sensory-discriminative, motivational-affective and cognitive-evaluative dimensions of ACS-related pain. Methods: A descriptive-correlational, repeated-measure design was used to collect data on 121 ACS patients of their cardiac pain intensity. The (numeric rating scale-NRS 0-10 scale) measured chest pain “Now” and “Worst pain in the previous 2 hours over 8 hours” and the McGill Pain Questionnaire Short-Form (MPQ-SF) measured pain at 4 hours. Results: Mean age was 67.6 ± 13, 50% were male, 60% had unstable angina and 40% had Non-ST-elevation myocardial infarction. Cardiac pain intensity scores remained in the mild range from 1.1 ± 2.2 to 2.4 ± 2.7. MPQ-SF: 66% described pain as distressing and 26% reported pain was horrible or excruciating. Participants described ACS pain quality as acute injury (nociceptive pain: heavy, cramping, stabbing), as nerve damage (neuropathic: gnawing, hot-burning, shooting) and as a mixture of acute and chronic pain qualities (aching, tender and throbbing). Conclusions: Patients reported both nociceptive and neuropathic cardiac pain. It is unclear if pain perceptions are due to: i) pathophysiology of clot formation, ii) occurrence of a first or repeated ACS episode, or iii) complex co-morbidities. Pain arising from ACS requires an understanding of the interplay of ischemic, metabolic and neuropathophysiological mechanisms that contribute to complex cardiac pain experiences.
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O’Keefe-McCarthy et al. (2017) conducted an observational in Acute Coronary Syndrome (n=121). Patients with acute coronary syndrome reported mild cardiac pain intensity and described their pain using a complex mixture of both nociceptive and neuropathic pain qualities.
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