Study Documents Chronic Pain Associated With Sickle Cell Disease

Sickle cell disease (SCD), the most common inherited blood disorder in the United States, is marked by episodes of acute pain, but there is increasing recognition that it can transition to chronic persistent SCD pain. A recent study found that the presence of pain on 3 or more days a week is independently associated with worse patient-reported pain interference and anxiety.

This chronic pain is a major cause of morbidity and impaired quality of life, including lower employment.

One of the core diagnostic criteria used by Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy to define chronic SCD pain is the presence of pain on a “majority of days” in the past 6 months in 1 or more locations. The frequency characteristic of “majority of days” comes from the criteria of 15 days or more per month, used to define chronic migraine, but there are inadequate data to support this cutoff in SCD, researchers wrote in the Journal of Pain Research.

Using an existing dataset of adults with SCD who completed patient-reported outcomes of pain interference, physical functioning, anxiety, depression, and fatigue using the National Institutes of Health patient-reported outcomes measures information system (PROMIS) short-form instruments, researchers examined the association of the presence of pain on 3 or more days per week with patient-reported outcomes of functioning.

Participants were enrolled in a randomized clinical trial of the use of a web-based decision aid for examining therapeutic options in SCD. Of the 120 participants enrolled in this trial, 79 were adults with SCD and the remaining were caregivers/parents of adults with SCD. Of the 79 adults, 47 completed PROMIS questionnaires at baseline.

In unadjusted analyses, presence of pain on 3 or more days a week was associated with higher median PROMIS scores of pain interference, anxiety, and depression. Median PROMIS scores of fatigue and physical function were worse in women compared with men in unadjusted analyses.

These data support the clinical relevance of the frequency characteristic of pain on a “majority of days” in the definition of chronic SCD pain and provide the rationale for prospective studies to validate the clinical definition of chronic pain in SCD, the authors wrote.

After adjustment for age and sex, the presence of pain on 3 or more days a week was found to be associated with worse pain interference and anxiety. These data support the clinical relevance of the frequency characteristic of pain on a “majority of days” in the definition of chronic SCD pain and provide the rationale for prospective studies to validate the clinical definition of chronic pain in SCD.

This study also highlights the impact SCD has on functioning. The entire cohort experienced worse patient-reported pain interference, anxiety, depression, fatigue, and physical function, with a magnitude of 0.5—1 standard deviations different from the population norms.

The authors said the scores in adults with SCD are worse than reference norms of PROMIS scores for individuals with cancer in the Surveillance, Epidemiology, and End Results registry, highlighting the under-recognized toll of this disease. There was no difference in median PROMIS pain scores between adults 35 years old or younger, compared with those 35 years or older.

The Patient-Centered Outcomes Research Institute supported the study.

Reference

Bakshi N, Ross D, Krishnamurti L. Presence of pain on three or more days of the week is associated with worse patient reported outcomes in adults with sickle cell disease. J Pain Res. 2018;(11):313—318. doi.org/10.2147/JPR.S150065 Published February 9, 2018. Accessed February 13, 2018.