Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease

• Type of Material: Article
• Authors: Rachel Astles, Emory University; Zihao Liu, Emory University; Scott E. Gillespie, Emory University; Kristina W. Lai, Children's Healthcare of Atlanta; Alexander Maillis, Children's Healthcare of Atlanta; Claudia Morris, Emory University; Peter Lane Jr, Emory University; Lakshmanan Krishnamurti, Emory University; Nitya Bakshi, Emory University
• Language: English
• Date: 2023-09-07
• Publisher: Wolters Kluwer Health, Inc
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/PR9.0000000000001084
• Title of Journal or Parent Work: Pain Reports
• Volume: 8
• Issue: 5
• Start Page: E1084
• End Page: E1084
• Grant/Funding Information: The authors acknowledge the support and contributions from Children's Healthcare of Atlanta and Emory University Pediatric Biostatistics Core. The authors acknowledge support from the Children's Healthcare of Atlanta Sickle Cell Disease Health Services and Outcomes Program. The authors acknowledge Ashna Jagtiani, MBBS, MPH, for assistance with editing the manuscript.; N. Bakshi received funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number 1K23HL140142 and 1K23HL140142-03S1. N. Bakshi received funding from the Program for Retaining, Supporting, and EleVating Early-career Researchers at Emory (PeRSEVERE) from the Emory School of Medicine, a gift from the Doris Duke Charitable Foundation, and through the Georgia Clinical and Translational Science Alliance under award UL1-TR002378. C. R. Morris received funding from the National Center for Complementary and Integrative Health K24AT009893-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
• Keywords: Trajectories; Pain; Pain episode; Vaso-occlusive crisis; Sex; Sickle cell
• Research Categories: Biology, Cell

Abstract

Introduction/Objective:Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED).Methods:Retrospective review of electronic health records from a large, multicampus, pediatric SCD program.Results:Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED.Conclusion:Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.