Author(s)

Sheila O’Keefe-McCarthy^1*, Michael McGillion², Charles J. Victor³, Sheila Rizza⁴, Judith McFetridge-Durdle⁵

¹Brock University, St. Catharines, Ontario, Canada.
²Heart and Stroke Foundation/Michael G. De Groote Endowed Chair in Cardiovascular Nursing Research, School of Nursing, Faculty of Health Sciences, Hamilton, Ontario, Canada.
³University of Toronto, Toronto, Ontario, Canada.
⁴Nurse Practitioner Heart Failure Clinic, Trillium Health Partners-Credit Valley Site, Mississauga, Ontario, Canada.
⁵Florida State University College of Nursing, Tallahassee, Florida, US.

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.

Acute Coronary Syndromes, Nociceptive Pain, Neuropathic Pain, Pain Descriptors, Emergency Department

O’Keefe-McCarthy, S. , McGillion, M. , J. Victor, C. , Rizza, S. and McFetridge-Durdle, J. (2017) Nociceptive and Neuropathic Pain Qualities in Men and Women with Acute Coronary Syndromes: A Complex Pain Presentation. Open Journal of Nursing, 7, 331-344. doi: 10.4236/ojn.2017.73027.