Daily Assessment of Pain in Adults with Sickle Cell Disease

Abstract

Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.

Intensive management of high‐utilizing adults with sickle cell disease lowers admissions

“…Ninety-five percent of children are now living to adulthood creating new medical, social, and financial challenges to the delivery of care for chronically ill adults [12]. Adults with SCD are more ill on a day-to-day basis than children due to chronic pain and end-organ dysfunction [3]. Despite the increased burden of disease in adults compared to children, there is still a relatively small group of patients that require a disproportionate amount of resources [4,7].…”

“…Many adults with SCD are chronically ill [2]. One-third of adults develop a chronic pain syndrome [3]. Others suffer from end-organ dysfunction with or without chronic pain [2].…”

A potent oral P‐selectin blocking agent improves microcirculatory blood flow and a marker of endothelial cell injury in patients with sickle cell disease

“…Regarding the lack of changes in daily pain scores observed, among several factors to be considered are the small sample size available for analysis, the limited period of daily exposure of the endothelium to active drug because of the short T max , and the relatively low pretreatment pain scores of our study patients. In addition, the reported variability of pain in patients with SCD and the chronic daily pain experienced by over half of adult patients with this condition make pain a challenging endpoint in this patient population [30]. Given the scientific rationale for P-selectin blockade in SCD, the CAIM data, the results of the Phase I study detailed above, and the positive results from the Phase II study, we submit that PPS holds promise as a potentially efficacious and well-tolerated agent in the longterm prophylactic therapy of SCD and suggest that a larger trial of a PPS compound with carefully selected endpoints appears warranted.…”

Reconsideration of Age as a Contraindication for Curative Therapy of Sickle Cell Disease

“…On average, affected individuals have 2.6 acute care encounters per year for pain, 4 and 30% of adults report pain on a daily basis. 5 In addition, the chronic vasoocclusion is associated with high rates of cerebrovascular disease, lung disease, renal impairment, and avascular necrosis of joints. Although chronic blood transfusion ameliorates the recurrence rate of some of these events, the risk of iron overload persists.…”