TY - JOUR
T1 - Understanding the Pain Experience and Treatment Considerations Along the Spectrum of Peripheral Artery Disease
T2 - A Scientific Statement From the American Heart Association
AU - Smolderen, Kim G.
AU - Ujueta, Francisco
AU - Buckley Behan, Deborah
AU - Vlaeyen, Johan W.S.
AU - Jackson, Elizabeth A.
AU - Peters, Madelon
AU - Whipple, Mary
AU - Phillips, Karran
AU - Chung, Jayer
AU - Mena-Hurtado, Carlos
AU - American Heart Association Council on Peripheral Vascular Disease
AU - Council on Cardiovascular and Stroke Nursing
AU - Council on Quality of Care and Outcomes Research
N1 - Publisher Copyright:
© 2025 American Heart Association, Inc.
PY - 2025/3
Y1 - 2025/3
N2 - Peripheral artery disease (PAD) is an atherosclerotic condition that affects a growing number of individuals worldwide, with estimates exceeding 220 million. One of the central hallmarks of PAD is lower extremity pain, which may present as intermittent claudication and atypical leg pain, and, in more severe cases, ischemic rest pain, neuropathic pain, or phantom limb pain in those who underwent amputation. Although the majority of individuals with PAD may experience pain that is chronic in nature, the pathogenesis and phenomenology of pain may differ. Nociceptive, inflammatory, and neuropathic mechanisms all play a role in the generation of pain. Pain in PAD results in severe disability and can copresent with distress, sickness behaviors such as avoidance and further deconditioning, and concomitant depression, anxiety, and addiction secondary to opioid use. These factors potentially lead to chronic pain interacting with a multitude of domains of functioning, including physical, emotional, and behavioral. Whereas pain is a normal adaptive response, self-defeating behaviors and cognitions contribute to the persistence or worsening of the chronic pain experience, disability, and distress. Much remains unknown about the phenomenology of pain in PAD and its clinical subgroups and how it affects outcomes. Borrowing from other chronic pain syndromes, multimodal pain management strategies that emphasize a biopsychosocial model have generated a solid evidence base for the use of cognitive behavioral approaches to manage pain. Multimodal pain management in PAD is not the norm, but theoretical pathways and road maps for further research, assessment, and clinical implementation are presented in this scientific statement.
AB - Peripheral artery disease (PAD) is an atherosclerotic condition that affects a growing number of individuals worldwide, with estimates exceeding 220 million. One of the central hallmarks of PAD is lower extremity pain, which may present as intermittent claudication and atypical leg pain, and, in more severe cases, ischemic rest pain, neuropathic pain, or phantom limb pain in those who underwent amputation. Although the majority of individuals with PAD may experience pain that is chronic in nature, the pathogenesis and phenomenology of pain may differ. Nociceptive, inflammatory, and neuropathic mechanisms all play a role in the generation of pain. Pain in PAD results in severe disability and can copresent with distress, sickness behaviors such as avoidance and further deconditioning, and concomitant depression, anxiety, and addiction secondary to opioid use. These factors potentially lead to chronic pain interacting with a multitude of domains of functioning, including physical, emotional, and behavioral. Whereas pain is a normal adaptive response, self-defeating behaviors and cognitions contribute to the persistence or worsening of the chronic pain experience, disability, and distress. Much remains unknown about the phenomenology of pain in PAD and its clinical subgroups and how it affects outcomes. Borrowing from other chronic pain syndromes, multimodal pain management strategies that emphasize a biopsychosocial model have generated a solid evidence base for the use of cognitive behavioral approaches to manage pain. Multimodal pain management in PAD is not the norm, but theoretical pathways and road maps for further research, assessment, and clinical implementation are presented in this scientific statement.
KW - AHA Scientific Statements
KW - pain
KW - pain management
KW - peripheral arterial disease
U2 - 10.1161/HCQ.0000000000000135
DO - 10.1161/HCQ.0000000000000135
M3 - (Systematic) Review article
SN - 1941-7705
VL - 18
SP - e000135
JO - Circulation : Cardiovascular Quality and Outcomes
JF - Circulation : Cardiovascular Quality and Outcomes
IS - 3
M1 - e000135
ER -