AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain

Field, Joshua J.; Ballas, Samir K.; Campbell, Claudia M.; Crosby, Lori E.; Dampier, Carlton; Darbari, Deepika S.; McClish, Donna K.; Smith, Wally R.; Zempsky, William T.

doi:10.1016/j.jpain.2018.12.003

Cited by 42 publications

(27 citation statements)

References 101 publications

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“…Conversely, recently published American Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria highlighted "persistent pain" as representing escalating pain frequencypain that is distinct from an acute VOC episode but that which does not meet the duration of chronic pain (eg, pain lasting >10 days but <6 months). 28 To limit confusion and allow for the specificity of "chronic SCD pain" to refer to a duration of 6 months, the more general term of persistent pain will be used in this manuscript related to ongoing SCD pain that is distinct from VOCs.…”

Section: Risks Associated With Scd and Persistent Painmentioning

confidence: 99%

Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease

Connolly

Bills

Hardy

2019

Pediatric Blood & Cancer

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Background Pain is a major complication of sickle cell disease (SCD), spanning vaso‐occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning. Procedure Eighty‐nine participants (ages 7‐16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners‐3 [Conners—third edition], and PedsQL™‐SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC‐V [Wechsler Intelligence Scale for Children‐fifth edition], WJ‐III [Woodcock Johnson Tests of Achievement—third edition], and WIAT‐III [Wechsler Individual Achievement Test—third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi‐square and independent sample t‐test analyses were used to assess group differences (those with vs without persistent pain). Results Patients with persistent pain (n = 18) reported lower health‐related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026). Conclusions Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.

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Section: Risks Associated With Scd and Persistent Painmentioning

confidence: 99%

Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease

Connolly

Bills

Hardy

2019

Pediatric Blood & Cancer

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“…According to age, the highest incidence is between ages 18-30. [19] In our study, mean age was 28.53±8.5. Tyagi et al [20] reported that painful crises were more frequent in HbSS genotype patients (62.5%) compared to HbSB patients, but was not statistically significant.…”

Section: Discussionmentioning

confidence: 53%

Patient-controlled analgesia and morphine consumption in sickle cell anemia painful crises: A new protocol

Bakır

Atıcı

Yıldırım

et al. 2020

Agri

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The sudden and rapidly increasing severity of pain in sickle cell anemia painful crises frequently requires the use of strong opioids. Patients require continuous administrations of various doses (increased/decreased) within the following hours. This study aims to retrospectively evaluate the effects of a structured protocol based on standardized Visual Analogue Scale (VAS) and Patient-controlled analgesia (PCA) patient demand count on morphine consumption in painful crises. Methods: A total of 177 painful crises of 93 patients who were administered morphine using the PCA method according to appropriate analgesia protocol between 2004-2018 were evaluated in this study. The demographic data, hemoglobin chromatography and genotypes, painful episode follow-up time, VAS scores before and after treatment, and daily morphine consumption of the patients were recorded. Morphine consumption during the crisis according to age groups and sex were compared. Results: Of the patients, 57% were homozygous hemoglobin type SS (HbSS). Mean morphine consumption with PCA method was 56.9±35.4 mg (min-max: 10-232 mg) and mean follow-up time was 3.4±2.1 days (min.-max.: 1-11). VAS scores were significantly lower after treatment (6.8±2.3 pre-treatment; 0.8±0.6 post-treatment) (p<0.05). Conclusion: To our knowledge, our study is the first structured protocol based on VAS and PCA demand data. We believe lower morphine dosage using PCA protocol according to the rapidly changing pain levels of the patients will provide effective analgesia. Prospective studies with fewer limitations will more effectively demonstrate the effectiveness of this protocol.

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“…We defined patients as having frequent pain, which could potentially skew the overall results, if they were at least 12 years old and had at least four admissions for VOE during the study time period. Due to the retrospective nature of this study, and thus the inability to determine the presence of daily pain for at least 6 months in all patients, the term "chronic pain" was avoided, as per recent definitions (Field et al, 2018). Variables assessed were: initial pain score in triage, the use of oral analgesia prior to presentation (adequate, defined as use of both an opioid and NSAID, inadequate, i.e.…”

Section: Methodsmentioning

confidence: 99%

Management of vaso‐occlusive episodes in the day hospital decreases admissions in children with sickle cell disease

et al. 2019

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Summary Acute vaso‐occlusive episodes (VOE) are the most common reason for presentation to the Emergency Department (ED) and inpatient admission in people living with sickle cell disease (SCD). The goal of this study was to compare the hospital admission rate for VOE from our centre’s day hospital (Pediatric Ambulatory Chemotherapy and Transfusion Unit; PACT) versus the ED, and to determine which factors influence admission rate. The study included a total of 370 visits involving 140 children with SCD with a mean age of 10·9 ± 5·5 years. The timing from triage to the first analgesic was significantly different between the PACT and the ED (median, 32 vs. 70 min, P < 0·0001). The initial choice of opioid dosage adhered to our centre’s guidelines 84% of the time in the PACT v. 45% in the ED for morphine (P = 0·0003) and 100% in the PACT vs. 43% (P = 0·002) for hydromorphone. The admission rate from the ED (57%) was significantly higher than that of the PACT (29%) even when accounting for differences in baseline variables (P = 0·0001). In conclusion, the odds of being admitted were 3·8 times higher if the patient was treated in the ED. Timely administration and appropriate dosing of intravenous opioids may change this outcome in the future.

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AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain

Cited by 42 publications

References 101 publications

Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease

Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease

Patient-controlled analgesia and morphine consumption in sickle cell anemia painful crises: A new protocol

Management of vaso‐occlusive episodes in the day hospital decreases admissions in children with sickle cell disease

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