Chronic Pain In Sickle Cell Disease Research Articles

Emergency Department Management of Acute Pain Episodes in Sickle Cell Disease

To characterize the initial management of patients with sickle cell disease and an acute pain episode, to compare these practices with the American Pain Society Guideline for the Management of Acute and Chronic Pain in Sickle-Cell Disease in the emergency department, and to identify factors associated with a delay in receiving an initial analgesic. This was a multicenter retrospective design. Consecutive patients with an emergency department visit in 2004 for an acute pain episode related to sickle cell disease were included. Exclusion criteria included age younger than 18 years. A structured medical record review was used to abstract data, including the following outcome variables: analgesic agent and dose, route, and time to administration of initial analgesic. Additional variables included demographics, triage level, intravenous access, and study site. Mann-Whitney U test or Kruskal-Wallis test and multivariate regression were used to identify differences in time to receiving an initial analgesic between groups. There were 612 patient visits, with 159 unique patients. Median time to administration of an initial analgesic was 90 minutes (25th to 75th interquartile range, 54-159 minutes). During 87% of visits, patients received the recommended agent (morphine or hydromorphone); 92% received the recommended dose, and 55% received the drug by the recommended route (intravenously or subcutaneously). Longer times to administration occurred in female patients (mean difference, 21 minutes; 95% confidence interval = 7 to 36 minutes; p = 0.003) and patients assigned triage level 3, 4, or 5 versus 1 or 2 (mean difference, 45 minutes; 95% confidence interval = 29 to 61 minutes; p = 0.00). Patients from study sites 1 and 2 also experienced longer delays. Patients with an acute painful episode related to sickle cell disease experienced significant delays to administration of an initial analgesic.

There is no Shame in Pain: Coping and Functional Ability in Adolescents with Sickle Cell Disease

Despite the tremendous resilience of children with sickle cell anemia, this chronic illness has a significant impact in adaptation in every major area of functioning—personal care, emotional, recreational, educational, and vocational. Assessment of functional ability may help us to develop a fuller understanding of the relationships among illness severity, pain, physical dysfunction, and psychosocial adjustment in this group. A major challenge in the assessment of sickle cell disease (SCD) pain still lies in finding a reliable behavior referent of pain. Unlike the experience in other pain states (procedure-related pain), physical impairment and functional disability are salient characteristics in chronic SCD pain and, therefore, may contribute significantly to evaluations of pain states (pain ratings, pain characteristics, and pain quality). This article seeks to explore the utility of functional ability as an index of pain and pain behavior in children and adolescents with sickle cell anemia.