Sexual violence as a precipitator of chronic pain in young adults with sickle cell disease

Abstract

The American Society of Hematology (ASH) Guidelines for sickle cell disease (SCD) define chronic pain as reports of ongoing pain present on most days over the past 6 months in either a single location or multiple locations. 1 Approximately 30% to 40% of adolescents and adults living with SCD have at least 1 episode of chronic pain. 1 Current ASH guidelines for managing chronic pain in individuals with SCD do not include an evaluation for trauma, specifically sexual violence, as a precipitating cause. 1 Individuals with SCD and a history of interpersonal violence exposure were almost 5 times more likely to report chronic pain and .6 times more likely to report the use of opiate-based medications daily. 2 Works et al established a significant relationship between chronic pain and a history of trauma. 3 Despite Works et al categorizing sexual abuse as a common traumatic experience, no study has explicitly evaluated the relationship between sexual violence as a source of trauma and chronic pain in individuals with SCD. 3 Guidelines for treating individuals with SCD urge for routine screening of depression and anxiety, but not for sexual violence-related trauma, a risk factor for opioid disorder disease. 1 In case 1, in 2015, an 18-year-old individual with hemoglobin SS was the victim of a sexually violent trauma that was not revealed to the SCD team until 2 years after the event when the patient was interviewed about the gradual change in their health care utilization. The individual was seen in the Emergency Department (ED) and hospitalized approximately once and received 2 prescriptions of opioids corresponding to 22.5 morphine equivalents 2 years before the traumatic event. The individual was seen in the ED 1 time and admitted 4 times and received 13 prescriptions of opioids corresponding to 3125 morphine equivalents 1 year before the traumatic event. The patient received 14 prescriptions of opioids corresponding to 3520 morphine equivalents 1 year after the event and 29 prescriptions of opioids corresponding to 8130 morphine equivalents 2 years after the event, a relative increase of 12.6% and 160.1%, respectively (Table 1 part A). All ED visits and hospitalizations were for pain (ED visits were distinct from the hospitalization visits).