Impact of PCA Strategies on Pain Intensity and Functional Assessment Measures in Adults with Sickle Cell Disease during Hospitalized Vaso-Occlusive Episodes

• Type of Material: Article
• Authors: Carlton D Dampier, Emory University; Carrie G. Wager, New England Research Institutes; Ryan Harrison, New England Research Institutes; Lewis L. Hsu, University of Illinois; Caterina P. Minniti, National Institutes of Health; Wally R. Smith, Virginia Commonwealth University
• Language: English
• Date: 2012-10
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012 Wiley Periodicals, Inc.
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1002/ajh.23302/abstract;jsessionid=335786C7B167B19A97DD8CD84371600B.f01t02
• Title of Journal or Parent Work: American Journal of Hematology
• ISSN: 0361-8609
• Volume: 87
• Issue: 10
• Start Page: E71
• End Page: E74
• Grant/Funding Information: Victor R. Gordeuk, MD, Sharmin Diaz, BSN, Georgetown-Howard Universities Center for Clinical and Translational Science and supported by the National Institutes of Health National Center for Research Resources, Grant U54 RR026076; Johns Hopkins University: Johns Hopkins Institute for Clinical and Translational Research; grant # U10 HL083721.; UNC Clinical and Translational Science Award," grant # UL1RR025747; This publication was made possible by Grant Number U10HL083721 from the National Heart, Lung, and Blood Institute, National Institutes of Health.
• Keywords: sickle cell disease; longitudinal models; pain
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Clinical trials of sickle cell disease (SCD) pain treatment usually observe only small decrements in pain intensity during the course of hospitalization. Sub-optimal analgesic management and inadequate pain assessment methods are possible explanations for these findings. In a search for better methods for assessing inpatient SCD pain in adults, we examined several pain intensity and interference measures in both arms of a randomized controlled trial comparing two different opioid PCA therapies. Based upon longitudinal analysis of pain episodes, we found that scores from daily average Visual Analogue Scales (VAS) and several other measures, especially the Brief Pain Inventory (BPI), were sensitive to change in daily improvements in pain intensity associated with resolution of vaso-occlusive pain. In this preliminary trial, the low demand, high basal infusion (LDHI) strategy demonstrated faster, larger improvements in various measures of pain than the high demand, low basal infusion (HDLI) strategy for opioid PCA dosing, however, verification in larger studies is required. The measures and statistical approaches used in this analysis may facilitate design, reduce sample size, and improve analyses of treatment response in future SCD clinical trials of vaso-occlusive episodes.