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Brown TR, Jansen MO, Rolin SA, Liu SA, Xu KY. The misuse of malingering diagnoses in individuals with sickle cell disease. Gen Hosp Psychiatry 2024; 87:157-158. [PMID: 38102021 PMCID: PMC10982992 DOI: 10.1016/j.genhosppsych.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Tashalee R Brown
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, Saint Louis, MO 63110, United States of America.
| | - Madeline O Jansen
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90095, United States of America
| | - Stephanie A Rolin
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States of America
| | - Shiyuan Anabeth Liu
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, United States of America
| | - Kevin Y Xu
- John T. Milliken Department of Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, United States of America; Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 4940 Children's Place, Saint Louis, MO 63110, United States of America.
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Dev P, Bavli N, Sims B, Foster J, Moscowitz A, Makris UE, Rambally S. Mindfulness and yoga therapy for acute pain in sickle cell disease. EJHaem 2024; 5:131-135. [PMID: 38406511 PMCID: PMC10887359 DOI: 10.1002/jha2.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 02/27/2024]
Abstract
There is a paucity of data regarding the use of non-pharmacologic therapies for pain in sickle cell disease. The purpose of this pilot study was to assess the acceptability and feasibility of video-guided mindfulness meditation, breathing exercises, and yoga, in addition to standard of care, during admission for painful vaso-occlusive crisis. Feasibility was demonstrated by the enrollment rate of > 90% and high level of participant engagement in the intervention. Acceptability was demonstrated by positive feedback obtained in post-intervention surveys and the majority of subjects who expressed interest in participating in future mindfulness and yoga therapy sessions.
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Affiliation(s)
- Pallavi Dev
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Natalie Bavli
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Brittney Sims
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Jenny Foster
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Anna Moscowitz
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Una E. Makris
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
| | - Siayareh Rambally
- Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
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Kenney MO, Wilson S, Shah N, Bortsov A, Smith WR, Little J, Lanzkron S, Kanter J, Padrino S, Owusu-Ansah A, Cohen A, Desai P, Manwani D, Rehman SSU, Hagar W, Keefe F. Biopsychosocial Factors Associated With Pain and Pain-Related Outcomes in Adults and Children With Sickle Cell Disease: A Multivariable Analysis of the GRNDaD Multicenter Registry. J Pain 2024; 25:153-164. [PMID: 37544393 DOI: 10.1016/j.jpain.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
Pain is the primary symptomatic manifestation of sickle cell disease (SCD), an inherited hemoglobinopathy. The characteristics that influence pain experiences and outcomes in SCD are not fully understood. The primary objective of this study was to use multivariable modeling to examine associations of biopsychosocial variables with a disease-specific measure of pain interference known as pain impact. We conducted a secondary analysis of data from the Global Research Network for Data and Discovery national SCD registry. A total of 657 children and adults with SCD were included in the analysis. This sample was 60% female with a median age of 34 (interquartile range 26-42 years) and a chronic pain prevalence of 64%. The model accounted for 58% of the variance in pain impact. Low social (P < .001) and emotional (P < .001) functioning, increasing age (P = .004), low income (P < .001), and high acute painful episodes (P = .007) were most strongly associated with high pain impact in our multivariable model. Additionally, multivariable modeling of pain severity and physical function in 2 comparable samples of registry participants revealed that increasing age and low social functioning were also strongly associated with higher pain severity and low physical functioning. Overall, the results suggest that social and emotional functioning are more strongly associated with pain impact in individuals with SCD than previously studied biological modifiers such as SCD genotype, hemoglobin, and percentage fetal hemoglobin. Future research using longitudinally collected data is needed to confirm these findings. PERSPECTIVE: This study reveals that psychosocial (ie, social and emotional functioning) and demographic (ie, age) variables may play an important role in predicting pain and pain-related outcomes in SCD. Our findings can inform future multicenter prospective longitudinal studies aimed at identifying modifiable psychosocial predictors of adverse pain outcomes in SCD.
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Affiliation(s)
- Martha O Kenney
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University, Durham, North Carolina
| | - Samuel Wilson
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirmish Shah
- Departments of Pediatrics & Hematology, Duke University, Durham, North Carolina
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Duke University, Durham, North Carolina
| | - Wally R Smith
- Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jane Little
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sophie Lanzkron
- Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama, Birmingham, Alabama
| | - Susan Padrino
- School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Alice Cohen
- Division of Hematology and Oncology, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Payal Desai
- Levin Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, New York
| | - Sana Saif Ur Rehman
- Department of Medicine, Division of Hematology, Washington University School of Medicine, St. Louis, Missouri
| | - Ward Hagar
- Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, California
| | - Francis Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina
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Joseph L, Driessen M. A comprehensive view of pregnancy in patients with sickle cell disease in high-income countries: the need for robust data and further decline in morbidity and mortality. Lancet Haematol 2024; 11:e75-e84. [PMID: 38135375 DOI: 10.1016/s2352-3026(23)00310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
Sickle cell disease is a major public health concern due to its prevalence and associated morbidities. In high-income countries, diagnosis and treatment advancements have extended patient's lives and enabled women to embrace motherhood. Although the provision of care in specialist centres has reduced maternal-fetal complication rates, the mortality rate among pregnant women with sickle cell disease remains disproportionately high. Complications arise from vaso-occlusive events, worsening organ damage, thrombotic risks, infections, and pregnancy-related issues, such as pre-eclampsia, premature birth, small-for-gestational-age, and pregnancy loss. Effective management during pregnancy includes preconception planning, genetic counselling, education, and collaborative care. There is no consensus on the overall approach to managing pregnant women with sickle cell disease; however, fostering a collaborative relationship between health-care professionals and researchers is crucial for advancing the understanding and management of this illness. The disparities in health-care outcomes associated with ethnicity and economic insecurity affect patients with sickle cell disease but have not been examined extensively. Hence, health-care personnel need sufficient training to address these issues alongside broader societal efforts to confront racism and discrimination. Comprehensive national and global action plans are required to address the multifaceted challenges of sickle cell disease.
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Affiliation(s)
- Laure Joseph
- Biotherapy Department, French National Sickle Cell Referral Centre, Biotherapy Clinical Investigation Centre, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Marine Driessen
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France
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Connolly ME, Forman S, Sharkey CM, Merwin S, Darbari DS, Hardy SJ. Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease. Pediatr Blood Cancer 2023; 70:e30667. [PMID: 37726889 DOI: 10.1002/pbc.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking. METHODS Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills. RESULTS All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05). CONCLUSIONS The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Christina M Sharkey
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Merwin
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Deepika S Darbari
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
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Pontes-Silva A. We are looking at fibromyalgia as usual: a discussion of the meaning and consequences of fibromyalgia in the biomedical model. Semin Arthritis Rheum 2023; 63:152261. [PMID: 37683514 DOI: 10.1016/j.semarthrit.2023.152261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Affiliation(s)
- André Pontes-Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil.
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Anderson D, Lien K, Agwu C, Ang PS, Abou Baker N. The Bias of Medicine in Sickle Cell Disease. J Gen Intern Med 2023; 38:3247-3251. [PMID: 37698721 PMCID: PMC10651605 DOI: 10.1007/s11606-023-08392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/22/2023] [Indexed: 09/13/2023]
Abstract
Sickle cell disease (SCD) is the most common monogenetic condition in the United States (US) and one that has been subjected to a history of negative bias. Since SCD was first described approximately 120 years ago, the medical establishment has, directly and indirectly, harmed patients by reinforcing biases and assumptions about the disease. Furthermore, negative biases and stigmas have been levied upon patients with SCD by healthcare providers and society, researchers, and legislators. This article will explore the historical context of SCD in the US; discuss specific issues in care that lead to biases, social and self-stigma, inequities in access to care, and research funding; and highlight interventions over recent years that address racial biases and stigma.
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Affiliation(s)
- Daniela Anderson
- Tapestry 360 Health Center, Chicago, IL, USA
- Department of Family Medicine, University of Chicago, Chicago, IL, USA
| | - Katie Lien
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Chibueze Agwu
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Phillip S Ang
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Nabil Abou Baker
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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Sidhom D, Aboul-Hassan D, Clauw DJ, Cofield C, Bergmans R. Chronic pain management in sickle cell disease: A systematic scoping review of controlled trials. Crit Rev Oncol Hematol 2023; 190:104087. [PMID: 37541536 DOI: 10.1016/j.critrevonc.2023.104087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023] Open
Abstract
Existing treatment for chronic pain in sickle cell disease (SCD) is opioid-dependent, which is ineffective and carries risks. We conducted a scoping literature review to assess the size and scope of available literature about controlled trials of therapies for SCD chronic pain and identify research gaps. The search strategy in PubMed and EMBASE utilized keywords for chronic pain and sickle cell and identified seven original articles that met inclusion criteria. Six of the studies recruited from clinics while one recruited from community sources. Cannabis and behavioral modification were associated with improvements in pain scores. However, existing evidence does not represent best practices for assessing chronic pain, and this along with small sample sizes prevents translation to clinical care. The limited evidence concerning treatment for SCD chronic pain highlights the need for larger trials of opioid alternatives and the utilization of chronic pain measures that capture nociplastic pain in SCD.
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Affiliation(s)
- David Sidhom
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Cherie Cofield
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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Pontes-Silva A, Nunes I, De Miguel-Rubio A, de Souza MC, DeSantana JM, Avila MA. Social variables for replication of studies using mean scores of social support, self-care, and fibromyalgia knowledge: a cross-sectional study. Rheumatol Int 2023; 43:1705-1721. [PMID: 37335339 DOI: 10.1007/s00296-023-05374-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
To investigate biopsychosocial variables that contribute to explaining social support, self-care, and fibromyalgia knowledge in patients with fibromyalgia. A cross-sectional study. We built ten models of predictive variables (schooling, ethnicity, associated diseases, body regions affected by pain, employment status, monthly income, marital status, health level, medication, sports activities, interpersonal relationships, nutrition level, widespread pain, symptom severity, cohabitation, dependent people, number of children, social support, self-care, and fibromyalgia knowledge) and individually tested their explanatory performance to predict mean scores on the Fibromyalgia Knowledge Questionnaire (FKQ), Medical Outcomes Study's Social Support Scale (MOS-SSS), and Appraisal of Self-Care Agency Scale-Revised (ASAS-R). We used analysis of variance to verify the association among all variables of mathematically adjusted models (F-value ≥ 2.20) and we reported only models corrected with p < 0.05 and R2 > 0.20. One hundred and ninety people with fibromyalgia (aged 42.3 ± 9.7 years) participated in the study. Our results show that the variables schooling, ethnicity, body regions affected by pain, frequency of sports activities, dependent people, number of children, widespread pain, social support, and self-care determine 27% of the mean FKQ scores. Marital status, self-care, and fibromyalgia knowledge determine 22% of mean MOS-SSS scores. Schooling, ethnicity, employment status, frequency of sports activities, nutrition level, cohabitation, number of children, social support, and fibromyalgia knowledge determine 30% of the mean ASAS-R scores. Studies using mean scores of social support, self-care, and fibromyalgia knowledge should collect and analyze the social variables described in the present study.
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Affiliation(s)
- André Pontes-Silva
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | - Isadora Nunes
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | | | - Marcelo Cardoso de Souza
- Postgraduate Program in Rehabilitation Sciences, Department of Physical Therapy, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Josimari Melo DeSantana
- Department of Physical Therapy, Graduate Program in Health Science and Graduate Program in Physiological Science, Universidade Federal de Sergipe, Aracaju, SE, Brazil
| | - Mariana Arias Avila
- Study Group on Chronic Pain (NEDoC), Laboratory of Research on Electrophysical Agents (LAREF), Physical Therapy Department, Universidade Federal de São Carlos, Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.
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