Non-pharmacological and non-invasive interventions for chronic pain in people with Chronic Obstructive Pulmonary Disease: A Protocol for a Mixed Methods Systematic Review

Chronic Obstructive Pulmonary Disease (COPD) is a debilitating, non-reversible lung disease. Prevalence of chronic pain in people with COPD is reported to be between 32-66% (9,10). Despite this, pain management is not yet reflected in current treatment guidelines (2,7). This mixed methods systematic review will use a convergent, segregated, results-based approach to synthesise the current knowledge from interventions addressing chronic pain in individuals with COPD. Individuals with a confirmed diagnosis of COPD (GOLD stages 1-4) will be included, along with any nonpharmacological, non-invasive interventions delivered in various settings. Studies will be eligible for inclusion if they are randomised/non-randomised controlled trials and include an outcome to assess pain. Fourteen electronic databases will be searched involving a combination of MeSH and keywords up to April 2020. Hand, citation and grey literature searching will also be conducted.
Joanna Briggs Institute (JBI) data extraction tools and critical appraisal instruments will be adapted to assess studies. Quantitative data will include specific details about participants, COPD severity, setting, interventions, pain outcomes, non-pain outcomes and measures used. Qualitative data will comprise codes, themes/subthemes with corresponding illustrative quotes. Grades of evidence will be reported in line with the JBI recommendations.
A meta-analysis will be undertaken to calculate a pooled treatment effect of interventions that have assessed pain as an outcome in individuals with COPD. We will assess the impact these interventions have on pain in COPD and attempt to identify the behavioural components of interventions associated with effective management of pain. Qualitative data from included studies will be subjected to a meta-synthesis to explore views of people with COPD and health care professionals involved in these interventions and examine implementation issues. The conclusions will be used to inform the development of an evidence- and theory-based intervention to manage pain in people with COPD.