Research Explores Factors Linked With SCD Pain Severity, Frequency

Employment status, age, sex, and depression are all linked with pain frequency among patients with sickle cell disease (SCD), findings from a cross-sectional analysis show.

Results were published in JAMA Network Open.

Pain is a key symptom of SCD and often contributes to increased health care utilization and hospitalizations, researchers explained. The pain these patients experience is also complex and does not occur in isolation, they added.

Previous research shows that SCD complications in patients are linked with social determinants of health, while family-level and neighborhood-level socioeconomic status can impact pain level, frequency, and patient quality of life.

What’s more, “mental health is related to opioid use for SCD-related pain and can be seen in stress and negative coping behaviors experienced by individuals with SCD,” the authors said. Patients with SCD also have depression rates approximately 3 times higher than the general population.

To better understand the association between pain episode frequency and severity among patients and factors like educational attainment, employment status, and mental health, the investigators recruited individuals from 8 clinical centers participating in the Sickle Cell Disease Implementation Consortium.

A total of 2264 patients with SCD were included in the study. All participants were aged 15 to 45 years. Patient registry data were collected between 2017 and 2018 and analyses were carried out between September 2020 and March 2022. The researchers assessed electronic medical records and findings from participant surveys. Of those included in the study, 56.2% were female.

The results show almost half of participants said they took a daily medication for pain and/or used hydroxyurea, just under 30% said they received regular blood transfusions, and 20% had received a diagnosis of depression.

Pain-specific measurements revealed 79.8% of patients had severe pain and 47.8% had more than 4 pain episodes in the past year.

Both educational attainment and income were not linked with increased pain frequency or severity, the researchers found. However, their analyses revealed several important findings:

• Unemployment (β, 2.13; 95% CI, 0.99-3.23; P < .001) and female sex (β, 1.78; 95% CI, 0.80-2.76; P < .001) were linked with increased pain frequency
• Being younger than age 18 was inversely associated with pain frequency (β, −5.72; 95% CI, −7.72 to −3.72; P < .001) and pain severity (β, 5.10; 95% CI, −6.70 to −3.51; P < .001)
• Depression was linked with increased pain frequency (β, 2.18; 95% CI, 1.04-3.31; P < .001) but not pain severity
• Hydroxyurea use was associated with heightened pain severity (β, 1.36; 95% CI, 0.47-2.24; P = .003)
• Taking daily medication for pain was associated with both increased pain frequency (β, 6.29; 95% CI, 5.28-7.31; P < .001) and severity (β, 2.87; 95% CI, 1.95-3.80; P < .001)

Based on the findings, the researchers note “depression screening for these patients is warranted, especially among those experiencing higher pain frequency and severity.”

In addition, “comprehensive treatment and pain reduction must consider the full experiences of patients with SCD, including impacts on mental health,” they added.

The investigators also stressed the importance of the link between depression and pain episode frequency, as SCD has a disproportional impact on individuals of African descent. Black youth with SCD also tend to encounter stigma when they seek care for vaso-occlusive crises, a condition that can result in severe anemia and end-organ damage.

“Without proper screening and assessments for depression, we might overestimate other factors and overlook key factors or outcomes in this population,” the researchers concluded. “Further investigation is needed to both understand depression among this population and its association with SCD-related pain.”

Reference

Harris KM, Preiss L, Varughese T, et al. Examining mental health, education, employment, and pain in sickle cell disease. JAMA Netw Open. Published online May 18, 2023. doi:10.1001/jamanetworkopen.2023.14070