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Astles R, Liu Z, Gillespie SE, Lai KW, Maillis A, Morris CR, Lane PA, Krishnamurti L, Bakshi N. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep 2023; 8:e1084. [PMID: 37559677 PMCID: PMC10409410 DOI: 10.1097/pr9.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction/Objective Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED). Methods Retrospective review of electronic health records from a large, multicampus, pediatric SCD program. Results Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED. Conclusion Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
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Affiliation(s)
- Rachel Astles
- Emory University School of Medicine, Atlanta, GA, USA
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott E. Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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Shearer HM, Côté P, Hogg‐Johnson S, Mckeever P, Fehlings DL. Pain trajectories and well-being in children and young people with cerebral palsy: A cohort study. Dev Med Child Neurol 2022; 64:1416-1424. [PMID: 35489074 PMCID: PMC9790202 DOI: 10.1111/dmcn.15252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/12/2022] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
AIM To identify 5-week pain intensity trajectories and their association with physical and psychological well-being in children/young people with cerebral palsy (CP). METHOD A cohort study was conducted with 101 Canadian children/young people with CP, of whom 49 were female, with an overall mean age of 12 years 11 months (SD 3 years 1 month), range of 8 to 18 years, and classified in any Gross Motor Function Classification System level. Self-reported pain intensity (Faces Pain Scale - Revised) was collected weekly for 5 weeks and physical and psychological well-being (KIDSCREEN-27) at baseline and 5 weeks. Statistical analyses included latent class growth and general linear models. RESULTS All Gross Motor Function Classification System levels were represented (I = 40.6%; II = 15.8%; III = 20.8%; IV = 13.9%; V = 8.9%). Five pain intensity trajectories were identified. Three trajectories had very low (35.4%), low (32.4%), or high (4.9%) mean stable pain. Two trajectories had moderate changing pain (16.8%) and high pain decreasing to moderate levels (10.5%) respectively. Trajectory participants with stable high pain had the lowest physical well-being (adjusted β = -10.01; 95% confidence interval [CI] = -19.37 to -0.66). Those in the three trajectories with the highest mean baseline pain intensity (>3 out of 10) had the lowest psychological well-being (adjusted β = -8.27, 95% CI = -14.84 to -1.70; β = -6.74, 95% CI = -12.43 to -1.05; β = -5.82, 95% CI = -15.34 to 3.71). INTERPRETATION Almost one-third of participants had moderate-to-high pain intensity trajectories. Membership in the higher pain intensity trajectories was associated with lower physical and psychological well-being. WHAT THIS PAPER ADDS Five distinct 5-week pain intensity trajectories were identified in children/young people with cerebral palsy. Thirty-two per cent of participants had moderate-to-high pain intensity trajectories. Participants in the trajectories with higher pain intensity reported lower physical and psychological well-being.
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Affiliation(s)
- Heather M. Shearer
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Holland Bloorview Kids Rehabilitation HospitalTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada
| | - Pierre Côté
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada
| | - Sheilah Hogg‐Johnson
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Institute for Disability and Rehabilitation Research, Faculty of Health SciencesOntario Tech UniversityOshawaONCanada,Dalla Lana School of Public HealthUniversity of TorontoTorontoONCanada,Research and InnovationCanadian Memorial Chiropractic CollegeTorontoONCanada
| | | | - Darcy L. Fehlings
- Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoONCanada,Holland Bloorview Kids Rehabilitation HospitalTorontoONCanada,Department of PaediatricsUniversity of TorontoTorontoONCanada
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