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Allison RL, Welby E, Ehlers V, Burand A, Isaeva O, Nieves Torres D, Highland J, Brandow AM, Stucky CL, Ebert AD. Sickle cell disease iPSC-derived sensory neurons exhibit increased excitability and sensitization to patient plasma. Blood 2024; 143:2037-2052. [PMID: 38427938 PMCID: PMC11143522 DOI: 10.1182/blood.2023022591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/25/2024] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
ABSTRACT Individuals living with sickle cell disease (SCD) experience severe recurrent acute and chronic pain. Challenges to gaining mechanistic insight into pathogenic SCD pain processes include differential gene expression and function of sensory neurons between humans and mice with SCD, and extremely limited availability of neuronal tissues from patients with SCD. Here, we used induced pluripotent stem cells (iPSCs), derived from patients with SCD, differentiated into sensory neurons (SCD iSNs) to begin to overcome these challenges. We characterize key gene expression and function of SCD iSNs to establish a model to investigate intrinsic and extrinsic factors that may contribute to SCD pain. Despite similarities in receptor gene expression, SCD iSNs show pronounced excitability using patch clamp electrophysiology. Furthermore, we find that plasma taken from patients with SCD during acute pain associated with a vaso-occlusive event increases the calcium responses to the nociceptive stimulus capsaicin in SCD iSNs compared with those treated with paired plasma from patients with SCD at steady state baseline or healthy control plasma samples. We identified high levels of the polyamine spermine in baseline and acute pain states of plasma from patients with SCD, which sensitizes SCD iSNs to subthreshold concentrations of capsaicin. Together, these data identify potential intrinsic mechanisms within SCD iSNs that may extend beyond a blood-based pathology.
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Affiliation(s)
- Reilly L. Allison
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Emily Welby
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Vanessa Ehlers
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Anthony Burand
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Olena Isaeva
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Damaris Nieves Torres
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI
| | - Janelle Highland
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Amanda M. Brandow
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Cheryl L. Stucky
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Allison D. Ebert
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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Allison RL, Burand A, Torres DN, Brandow AM, Stucky CL, Ebert AD. Sickle cell disease patient plasma sensitizes iPSC-derived sensory neurons from sickle cell disease patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.10.523446. [PMID: 36711992 PMCID: PMC9882050 DOI: 10.1101/2023.01.10.523446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Individuals living with sickle cell disease (SCD) experience severe recurrent acute and chronic pain. In order to develop novel therapies, it is necessary to better understand the neurobiological mechanisms underlying SCD pain. There are many barriers to gaining mechanistic insight into pathogenic SCD pain processes, such as differential gene expression and function of sensory neurons between humans and mice with SCD, as well as the limited availability of patient samples. These can be overcome by utilizing SCD patient-derived induced pluripotent stem cells (iPSCs) differentiated into sensory neurons (SCD iSNs). Here, we characterize the key gene expression and function of SCD iSNs to establish a model for higher-throughput investigation of intrinsic and extrinsic factors that may contribute to increased SCD patient pain. Importantly, identified roles for C-C Motif Chemokine Ligand 2 (CCL2) and endothelin 1 (ET1) in SCD pain can be recapitulated in SCD iSNs. Further, we find that plasma taken from SCD patients during acute pain increases SCD iSN calcium response to the nociceptive stimulus capsaicin compared to those treated with paired SCD patient plasma at baseline or healthy control plasma samples. Together, these data provide the framework necessary to utilize iSNs as a powerful tool to investigate the neurobiology of SCD and identify potential intrinsic mechanisms of SCD pain which may extend beyond a blood-based pathology.
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Affiliation(s)
- Reilly L. Allison
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Anthony Burand
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Damaris Nieves Torres
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI
| | - Amanda M. Brandow
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Cheryl L. Stucky
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Allison D. Ebert
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI
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Kenney MO, Smith WR. Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review. J Pain Res 2022; 15:879-894. [PMID: 35386424 PMCID: PMC8979590 DOI: 10.2147/jpr.s343069] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Purpose of Review Sickle cell disease (SCD) is an inherited hemoglobinopathy with potential life-threatening complications that affect millions of people worldwide. Severe and disabling acute pain, referred to as a vaso-occlusive crisis (VOC), is a fundamental symptom of the disease and the primary driver for acute care visits and hospitalizations. Despite the publication of guidelines for VOC management over the past decade, management of VOCs remains unsatisfactory for patients and providers. Recent Findings Acute SCD pain includes pain secondary to VOCs and other forms of acute pain. Distinguishing VOC from non-VOC pain may be challenging for both patients and clinicians. Further, although opioids have been the gold-standard for VOC pain management for decades, the current highest standard of care for all acute pain is a multimodal approach that is less dependent on opioids, and, instead incorporates analgesics and adjuvants from different mechanistic pathways. In this narrative review, we focus on a multimodal pharmacologic approach for acute SCD pain management and explore the evidence for existing non-opioid pharmacological adjuncts. Moreover, we present an explanatory model of pain, which is not only novel in its application to SCD pain but also captures the multidimensional nature of the SCD pain experience and supports the need for such a multimodal approach. This model also highlights opportunities for new investigative and therapeutic targets - both pharmacological and non-pharmacological. Summary Multimodal pain regimens that are less dependent on opioids are urgently needed to improve acute pain outcomes for individuals with SCD. The proposed explanatory model for SCD pain offers novel opportunities to improve acute pain management for SCD patients.
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Affiliation(s)
- Martha O Kenney
- Division of Pediatric Anesthesiology, Department of Anesthesiology, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Wally R Smith
- Division of General Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Amaeshi L, Kalejaiye OO, Ogamba CF, Adelekan Popoola F, Adelabu YA, Ikwuegbuenyi CA, Nwankwo IB, Adeniran O, Imeh M, Kehinde MO. Health-Related Quality of Life Among Patients With Sickle Cell Disease in an Adult Hematology Clinic in a Tertiary Hospital in Lagos, Nigeria. Cureus 2022; 14:e21377. [PMID: 35198289 PMCID: PMC8854203 DOI: 10.7759/cureus.21377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2022] [Indexed: 11/05/2022] Open
Abstract
Background Sickle cell disease (SCD) is a genetic disease of public health concern. Improved quality healthcare has increased the life expectancy of these patients; however, they also face an increased frequency of vaso-occlusive crises and other SCD complications. These complications affect their quality of life, an area of care, which healthcare providers often overlook. We sought to determine the health-related quality of life among patients living with sickle cell disease in Lagos, Nigeria. Materials and methods We conducted a cross-sectional study of 198 patients with sickle cell disease who attended the adult sickle cell clinic at a tertiary hospital in Lagos, Nigeria, during the period from October 1, 2018, to February 28, 2019. A self-administered questionnaire was used to obtain the clinical and socio-demographic characteristics of the patients and the 35-item Short-Form Health Survey (SF-36) questionnaire was used to determine their health-related quality of life (HRQoL). Determinants of HRQoL were established using bivariate and multivariate regression analysis. Results The mean age of the 198 patients who participated in the study was 28.4±9.1 years, mean steady-state hemoglobin was 8.2 ± 1.3 g/dl, and 85 (42.9%) patients had a monthly income of 150 USD or less. In the previous year, 65 (32.1 %) and 33 (16.6%) patients, respectively, suffered one to two episodes (s) of acute bone pain crises and acute chest syndrome, and 43 (24.7%) had blood transfusion. Using the scoring system for SF-36 provided by RAND Health, role limitation due to physical health had the lowest median score of 50 (interquartile range {IQR}: 0-100). On bivariate analysis, bone pain crisis was associated with statistically significant low scores across all the 8 HRQoL domains of the SF36 questionnaire. Other variables, including having received blood transfusion, recent hospitalization, acute chest syndrome, lower level of income, and younger age, were also associated with significantly low scores. On regression analysis, bone pain crisis, level of income, and acute chest syndrome were found to be independent determinants of quality of life in the patients. Conclusion Sickle cell disease has a negative impact on the health-related quality of life of those affected. The presence of bone pain crisis is an important predictor of health-related quality of life in sickle cell disease patients. To improve patient outcomes, healthcare providers should take a holistic approach in evaluating and managing this disease, taking into cognizance how the complications and the financial burden of this disease impact the quality of life of affected patients.
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OUP accepted manuscript. PAIN MEDICINE 2022; 23:1379-1386. [DOI: 10.1093/pm/pnac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/06/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022]
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Adegboyega LO. Counselling Needs of Sickle-Cell Anaemia Adolescents in Ekiti State, Nigeria. Ethiop J Health Sci 2021; 30:1005-1010. [PMID: 33883846 PMCID: PMC8047247 DOI: 10.4314/ejhs.v30i6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Sickle-cell disease is an autosomal recessive genetic disorder of hemoglobin (Hb) structure and the most common of the hemoglobinopathies. Hence, this study investigated counseling needs of sickle-cell anaemia adolescents in Ekiti State. Methods Descriptive survey design was adopted for this study. Purposive sampling technique was adopted to draw a total of 121 respondents. A questionnaire was used to collect data for the study. Mean and rank order were used to answer the research question while chi-square and Analysis of Variance (ANOVA) were used to test the hypotheses at 0.05 level of significance. Results The findings revealed that counselling needs of adolescents with sickle-cell anaemia include counsellors are expected to encourage adolescents with sickle-cell anaemia to have confidence in self among others. The findings also revealed that there was a significant difference in the counselling needs of adolescents with sickle-cell anaemia based on gender while there was no significant difference in the counselling needs of adolescents with sickle-cell anaemia based on religion. Conclusion The counselling needs of adolescents with sickle-cell anaemia include adolescents with sickle-cell anaemia easily comprehend the counselling therapy of counsellor among others. It was recommended that Government should offer standard health care for all adolescents with Sickle-cell disease.
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Ji Y, Chalacheva P, Rosen CL, DeBaun MR, Coates TD, Khoo MCK. Identifying elevated risk for future pain crises in sickle-cell disease using photoplethysmogram patterns measured during sleep: A machine learning approach. Front Digit Health 2021; 3. [PMID: 34396363 PMCID: PMC8360353 DOI: 10.3389/fdgth.2021.714741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transient increases in peripheral vasoconstriction frequently occur in obstructive sleep apnea and periodic leg movement disorder, both of which are common in sickle cell disease (SCD). These events reduce microvascular blood flow and increase the likelihood of triggering painful vaso-occlusive crises (VOC) that are the hallmark of SCD. We recently reported a significant association between the magnitude of vasoconstriction, inferred from the finger photoplethysmogram (PPG) during sleep, and the frequency of future VOC in 212 children with SCD. In this study, we present an improved predictive model of VOC frequency by employing a two-level stacking machine learning (ML) model that incorporates detailed features extracted from the PPG signals in the same database. The first level contains seven different base ML algorithms predicting each subject's pain category based on the input PPG characteristics and other clinical information, while the second level is a meta model which uses the inputs to the first-level model along with the outputs of the base models to produce the final prediction. Model performance in predicting future VOC was significantly higher than in predicting VOC prior to each sleep study (F1-score of 0.43 vs. 0.35, p-value <0.0001), consistent with our hypothesis of a causal relationship between vasoconstriction and future pain incidence, rather than past pain leading to greater propensity for vasoconstriction. The model also performed much better than our previous conventional statistical model (F1 = 0.33), as well as all other algorithms that used only the base-models for predicting VOC without the second tier meta model. The modest F1 score of the present predictive model was due in part to the relatively small database with substantial imbalance (176:36) between low-pain and high-pain subjects, as well as other factors not captured by the sleep data alone. This report represents the first attempt ever to use non-invasive finger PPG measurements during sleep and a ML-based approach to predict increased propensity for VOC crises in SCD. The promising results suggest the future possibility of embedding an improved version of this model in a low-cost wearable system to assist clinicians in managing long-term therapy for SCD patients.
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Affiliation(s)
- Yunhua Ji
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | | | - Carol L Rosen
- Department of Pediatrics, Case Western Reserve School of Medicine, Cleveland, OH
| | - Michael R DeBaun
- Division of Hematology-Oncology, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN
| | - Thomas D Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
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The Pan African Vivax and Ovale Network (PAVON): Refocusing on Plasmodium vivax, ovale and asymptomatic malaria in sub-Saharan Africa. Parasitol Int 2021; 84:102415. [PMID: 34216801 DOI: 10.1016/j.parint.2021.102415] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/26/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022]
Abstract
The recent World Malaria report shows that progress in malaria elimination has stalled. Current data acquisition by NMCPs depend on passive case detection and clinical reports focused mainly on Plasmodium falciparum (Pf). In recent times, several countries in sub-Saharan Africa have reported cases of Plasmodium vivax (Pv) with a considerable number being Duffy negative. The burden of Pv and Plasmodium ovale (Po) appear to be more than acknowledged. Similarly, the contribution of asymptomatic malaria in transmission is hardly considered by NMCPs in Africa. Inclusion of these as targets in malaria elimination agenda is necessary to achieve elimination goal, as these harbor hypnozoites. The Pan African Vivax and Ovale Network (PAVON) is a new consortium of African Scientists working in Africa on the transmission profile of Pv and Po. The group collaborates with African NMCPs to train in Plasmodium molecular diagnostics, microscopy, and interpretation of molecular data from active surveys to translate into policy. Details of the mission, rational and modus operandi of the group are outlined.
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Renedo A, Miles S, Chakravorty S, Leigh A, Warner JO, Marston C. Understanding the health-care experiences of people with sickle cell disorder transitioning from paediatric to adult services: This Sickle Cell Life, a longitudinal qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background
Transitions from paediatric to adult health-care services cause problems worldwide, particularly for young people with long-term conditions. Sickle cell disorder brings particular challenges needing urgent action.
Objectives
Understand health-care transitions of young people with sickle cell disorder and how these interact with broader transitions to adulthood to improve services and support.
Methods
We used a longitudinal design in two English cities. Data collection included 80 qualitative interviews with young people (aged 13–21 years) with sickle cell disorder. We conducted 27 one-off interviews and 53 repeat interviews (i.e. interviews conducted two or three times over 18 months) with 48 participants (30 females and 18 males). We additionally interviewed 10 sickle cell disease specialist health-care providers. We used an inductive approach to analysis and co-produced the study with patients and carers.
Results
Key challenges relate to young people’s voices being ignored. Participants reported that their knowledge of sickle cell disorder and their own needs are disregarded in hospital settings, in school and by peers. Outside specialist services, health-care staff refuse to recognise patient expertise, reducing patients’ say in decisions about their own care, particularly during unplanned care in accident and emergency departments and on general hospital wards. Participants told us that in transitioning to adult care they came to realise that sickle cell disorder is poorly understood by non-specialist health-care providers. As a result, participants said that they lack trust in staff’s ability to treat them correctly and that they try to avoid hospital. Participants reported that they try to manage painful episodes at home, knowing that this is risky. Participants described engaging in social silencing (i.e. reluctance to talk about and disclose their condition for fear that others will not listen or will not understand) outside hospital; for instance, they would avoid mentioning cell sickle disorder to explain fatigue. Their self-management tactics include internalising their illness experiences, for instance by concealing pain to protect others from worrying. Participants find that working to stay healthy is difficult to reconcile with developing identities to meet adult life goals. Participants have to engage in relentless self-disciplining when trying to achieve educational goals, yet working hard is incompatible with being a ‘good adult patient’ because it can be risky for health. Participants reported that they struggle to reconcile these conflicting demands.
Limitations
Our findings are derived from interviews with a group of young people in England and reflect what they told us (influenced by how they perceived us). We do not claim to represent all young people with sickle cell disorder.
Conclusions
Our findings reveal poor care for young people with sickle cell disorder outside specialist services. To improve this, it is vital to engage with young people as experts in their own condition, recognise the legitimacy of their voices and train non-specialist hospital staff in sickle cell disorder care. Young people must be supported both in and outside health-care settings to develop identities that can help them to achieve life goals.
Future work
Future work should include research into the understanding and perceptions of sickle cell disease among non-specialist health-care staff to inform future training. Whole-school interventions should be developed and evaluated to increase sickle cell disorder awareness.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Alicia Renedo
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sam Miles
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Andrea Leigh
- University College London NHS Hospitals Foundation Trust, London, UK
| | - John O Warner
- National Heart and Lung Institute, Imperial College London, London, UK
- Collaboration for Leadership in Applied Health Research and Care for Northwest London, Imperial College London, London, UK
| | - Cicely Marston
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Singh SA, Bakshi N, Mahajan P, Morris CR. What is the future of patient-reported outcomes in sickle-cell disease? Expert Rev Hematol 2020; 13:1165-1173. [PMID: 33034214 DOI: 10.1080/17474086.2020.1830370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is a complex, chronic disease caused by abnormal polymerization of hemoglobin, which leads to severe pain episodes, fatigue, and end-organ damage. Patient reported outcomes (PROs) have emerged as a critical tool for measuring SCD disease severity and response to treatment. AREAS COVERED Authors review the key issues involved when deciding to use a PRO in a clinical trial. We describe the most highly recommended generic and disease-specific PRO tools in SCD and discuss the challenges of incorporating them in clinical practice. EXPERT OPINION PRO measures are essential to incorporate into SCD clinical trials either as primary or secondary outcomes. The use of PRO measures in SCD facilitates a patient-centered approach, which is likely to lead to improved outcomes. Significant challenges remain in adapting PRO tools to routine clinical use and in developing countries.
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Affiliation(s)
- Sharon A Singh
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Nitya Bakshi
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University School of Medicine , Atlanta, GA, USA.,Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA
| | - Prashant Mahajan
- Department of Emergency Medicine and Pediatrics, University of Michigan Medical School , Ann Arbor, MI, USA
| | - Claudia R Morris
- Department of Pediatrics, Children's Healthcare of Atlanta , Atlanta, GA, USA.,Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine , Atlanta, GA, USA
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How I Treat Acute and Persistent Sickle Cell Pain. Mediterr J Hematol Infect Dis 2020; 12:e2020064. [PMID: 32952975 PMCID: PMC7485466 DOI: 10.4084/mjhid.2020.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/13/2020] [Indexed: 01/07/2023] Open
Abstract
Sickle pain is the hallmark of sickle cell disease (SCD). It could be acute, persistent/relapsing, chronic, or neuropathic. Although there is a general consensus that pain is a major manifestation of SCD, there is a controversy as to the types of pain and their interrelationship between acute, chronic, relapsing, persistent, etc. This report first reviews the general approach to the management of acute vaso-occlusive crisis (VOC) pain, including education, counseling, pharmacotherapy, non-pharmacotherapy, and fluid therapy. This is followed by the presentation of five patients that represent typical issues that are commonly encountered in the management of patients with SCD. These issues are: individualized treatment of pain, bilaterality of pain, use of illicit drugs, tolerance to opioids, opioid-induced hyperalgesia, and withdrawal syndrome. The clinical aspects and management of each of these issues are described. Moreover, such complications as tolerance and withdrawal may persist after discharge and may be mistaken as chronic pain rather than resolving, persistent or relapsing pain.
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Santos LFOD, Guimarães MW, Baptista AF, Sá KN. Impact of neuropathic pain on quality of life in adults with sickle cell disease: observational study. Hematol Transfus Cell Ther 2020; 43:263-267. [PMID: 32576453 PMCID: PMC8446234 DOI: 10.1016/j.htct.2020.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/07/2020] [Accepted: 03/29/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction Knowledge on the characteristics of neuropathic pain in people with sickle cell disease (SCD) may help to provide more effective treatment procedures. Objective To describe the characteristics of neuropathic pain in patients with sickle cell disease and identify the impact on their quality of life. Method A cross-sectional study (CAAE 57274516.8.0000.5544) was conducted at a reference center in Salvador, Bahia, Brazil. The instruments used were the Brief Pain Inventory (BPI), the Douleur Neuropatique Questionnaire (DN-4), the Anxiety and Depression Hospital scale (ADH) and the abbreviated version of the World Health Organization of Quality of Life questionnaire (WHOQOL-brief). The Mann-Whitney test was used to evaluate the association between the scores (5% alpha). Results A total of 100 adults with SCD participated in the study, 69.7% of whom had neuropathic pain. Anxiety was present in 99% of the sample and depression, in 100%. Patients with neuropathic pain had worse scores in all domains of quality of life (p < 0.05), but no association was found with pain intensity. Conclusion Neuropathic pain was more frequent than nociceptive pain in adults with SCD and generated worse scores in all domains of quality of life. Anxiety and depression were present in patients with both types of pain.
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Affiliation(s)
| | | | | | - Katia Nunes Sá
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brazil.
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13
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Takaoka K, Cyril AC, Jinesh S, Radhakrishnan R. Mechanisms of pain in sickle cell disease. Br J Pain 2020; 15:213-220. [PMID: 34055342 DOI: 10.1177/2049463720920682] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives The hallmark of sickle cell disease (SCD) is acute and chronic pain, and the pain dominates the clinical characteristics of SCD patients. Although pharmacological treatments of SCD targeting the disease mechanisms have been improved, many SCD patients suffer from pain. To overcome the pain of the disease, there have been renewed requirements to understand the novel molecular mechanisms of the pain in SCD. Methods We concisely summarized the molecular mechanisms of SCD-related acute and chronic pain, focusing on potential drug targets to treat pain. Results Acute pain of SCD is caused by vaso-occulusive crisis (VOC), impaired oxygen supply or infarction-reperfusion tissue injuries. In VOC, inflammatory cytokines include tryptase activate nociceptors and transient receptor potential vanilloid type 1. In tissue injury, the secondary inflammatory response is triggered and causes further tissue injuries. Tissue injury generates cytokines and pain mediators including bradykinin, and they activate nociceptive afferent nerves and trigger pain. The main causes of chronic pain are from extended hyperalgesia after a VOC and central sensitization. Neuropathic pain could be due to central or peripheral nerve injury, and protein kinase C might be associated with the pain. In central sensitization, neuroplasticity in the brain and the activation of glial cells may be related with the pain. Discussion In this review, we summarized the molecular mechanisms of SCD-related acute and chronic pain. The novel treatments targeting the disease mechanisms would interrupt complications of SCD and reduce the pain of the SCD patients.
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Affiliation(s)
- Kensuke Takaoka
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Asha Caroline Cyril
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | | | - Rajan Radhakrishnan
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
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Jhun EH, Sadhu N, He Y, Yao Y, Wilkie DJ, Molokie RE, Wang ZJ. S100B single nucleotide polymorphisms exhibit sex-specific associations with chronic pain in sickle cell disease in a largely African-American cohort. PLoS One 2020; 15:e0232721. [PMID: 32379790 PMCID: PMC7205279 DOI: 10.1371/journal.pone.0232721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/20/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pain in sickle cell disease (SCD) is severe and multifaceted resulting in significant differences in its frequency and intensity among individuals. In this study, we examined the influence of S100B gene single nucleotide polymorphisms (SNP) on acute and chronic pain variability in SCD. METHODS Composite pain index (CPI) scores captured chronic pain. Painful crisis related emergency care utilization recorded acute pain incidence. Genotyping was performed using MassARRAY iPLEX platform. RESULTS Regression analysis revealed associations of increased CPI with rs9722 A allele in additive (p = 0.005) and dominant (p = 0.005) models. Rs1051169 G allele on the other hand was associated with decreased CPI in additive (p = 0.001), and dominant (p = 0.005) models. Sex-specific analysis found that these associations were significant in females but not males in this cohort. Linkage analysis identified two haploblocks. Block 1 (rs9983698-rs9722) haplotype T-A was associated with increased CPI (p = 0.002) while block 2 (rs1051169-rs11911834) haplotype G-G was associated with decreased CPI (p = 0.001). Both haplotypic associations were only significant in females. No association of S100B SNPs with utilization reached statistical significance. CONCLUSIONS S100B SNPs and haplotypes are associated with chronic pain in female, but not male, patients with SCD, implicating a potential role of S100B polymorphism in SCD pain heterogeneity in a sex-dependent manner.
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Affiliation(s)
- Ellie H. Jhun
- Department of Pharmaceutical Sciences, University of Illinois College of Pharmacy, Chicago, Illinois, United States of America
| | - Nilanjana Sadhu
- Department of Pharmaceutical Sciences, University of Illinois College of Pharmacy, Chicago, Illinois, United States of America
| | - Ying He
- Department of Pharmaceutical Sciences, University of Illinois College of Pharmacy, Chicago, Illinois, United States of America
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Robert E. Molokie
- Department of Pharmaceutical Sciences, University of Illinois College of Pharmacy, Chicago, Illinois, United States of America
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Jesse Brown Veteran’s Administration Medical Center, Chicago, Illinois, United States of America
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States of America
| | - Zaijie Jim Wang
- Department of Pharmaceutical Sciences, University of Illinois College of Pharmacy, Chicago, Illinois, United States of America
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Department of Neurology & Rehabilitation, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States of America
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15
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Martin J, Le Faucheur L, Pondarré C, Carlier-Gonod A, Baeza-Velasco C. [Effects of a standardized musical intervention on the management of pain and anxiety-state of sickle-cell adolescents]. SOINS. PEDIATRIE, PUERICULTURE 2020; 41:35-41. [PMID: 32771206 DOI: 10.1016/j.spp.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The effect of a standardized musical intervention for adolescents with sickle cell disease was studied. Two groups were evaluated using the visual analog scale of pain and the anxiety-state inventory before and after a standardized musical intervention or breathing intervention. A significant decrease in scores was observed, most notably for the group benefiting from the standardized musical intervention. This intervention could be integrated into the overall management of adolescents with sickle cell disease.
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Affiliation(s)
- Jérémy Martin
- Service d'hospitalisation à domicile, Fondation Œuvre de la Croix-Saint-Simon, 35 rue du Plateau, 75019 Paris, France; Laboratoire de psychopathologie et processus de santé (EA 4057), Université de Paris, 71 avenue Édouard-Vaillant, 92774 Boulogne-Billancourt, France.
| | - Loïc Le Faucheur
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Corinne Pondarré
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Adèle Carlier-Gonod
- Service de médecine de l'adolescent, Centre hospitalier intercommunal de Créteil, 40 avenue de Verdun, 94000 Créteil, France
| | - Carolina Baeza-Velasco
- Laboratoire de psychopathologie et processus de santé (EA 4057), Université de Paris, 71 avenue Édouard-Vaillant, 92774 Boulogne-Billancourt, France; Département d'urgences & post-urgences psychiatriques, Hôpital Lapeyronie, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France
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16
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Sadhu N, Jhun EH, Posen A, Yao Y, He Y, Molokie RE, Wilkie DJ, Wang ZJ. Phenylethanolamine N-methyltransferase gene polymorphisms associate with crisis pain in sickle cell disease patients. Pharmacogenomics 2020; 21:269-278. [PMID: 32162598 DOI: 10.2217/pgs-2019-0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Phenylethanolamine N-methyltransferase (PNMT) catalyzes the conversion of sympathetic neurotransmitter norepinephrine to epinephrine. We examined the association of PNMT polymorphisms with acute and chronic pain in sickle cell disease (SCD). Methods: Utilization of emergency care owing to painful crisis was used as a marker for acute pain in 131 patients with SCD. Results: rs876493 A allele, rs2934965 T allele and rs2941523 G allele were significantly associated with decreased utilization (p ≤ 0.05). rs876493 A allele showed association with utilization in females (p = 0.003), not males (p = 0.803). rs2934965 T allele and rs2941523 G allele were predicted to cause loss of putative transcription factor binding sites. This is the first report of the association of PNMT polymorphisms with acute crisis pain in SCD. Together with our previous findings in catechol-o-methyltransferase, polymorphisms in catecholamine metabolizing enzymes appear to primarily influence acute pain in SCD.
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Affiliation(s)
- Nilanjana Sadhu
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Ellie H Jhun
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Andrew Posen
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown Veteran's Administration Medical Center, Chicago, IL, USA.,Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, FL, USA
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60607, USA.,Comprehensive Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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17
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Pal S, Dixit R, Moe S, Godinho MA, Abas ABL, Ballas SK, Ram S, Yousuf UAM. Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease. Cochrane Database Syst Rev 2020; 3:CD012762. [PMID: 32124977 PMCID: PMC7059961 DOI: 10.1002/14651858.cd012762.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sickle cell disease (SCD), one of the most common inherited disorders, is associated with vaso-occlusive pain episodes and haemolysis leading to recurrent morbidity, hospital admissions and work or school absenteeism. The crises are conventionally treated with opioids, non-opioids and other adjuvants with the risk of developing complications, addictions and drug-seeking behaviour. Different non-pharmacological treatments, such as transcutaneous electrical nerve stimulation (TENS) have been used for managing pain in other painful conditions. Hence, the efficacy of TENS for managing pain in SCD needs to be reviewed. OBJECTIVES To assess the benefits and harms of TENS for managing pain in people with SCD who experience pain crises or chronic pain (or both). SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Register, comprising of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We also searched online trial registries and the reference lists of relevant articles and reviews. Date of the last search: 26 Febraury 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs, where TENS was evaluated for managing pain in people with SCD. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of the trials identified by the literature searches according to the inclusion criteria. Two review authors then independently extracted data, assessed for risk of bias using the Cochrane standard tool and rated the quality of evidence using the GRADE guidelines. MAIN RESULTS One double-blind cross-over RCT with 22 participants with SCD (aged 12 to 27 years) was eligible for inclusion. Following stratification into four pain crises severity grades, participants were then randomised to receive TENS or placebo (sham TENS). The trial was concluded after 60 treatment episodes (30 treatment episodes of each treatment group). There is a lack of clarity regarding the trial design and the analysis of the cross-over data. If a participant was allocated to TENS treatment for an episode of pain and subsequently returned with a further episode of a similar degree of pain, they would then receive the sham TENS treatment (cross-over design). For those experiencing a pain episode of a different severity, it is not clear whether they were re-randomised or given the alternate treatment. Reporting and analysis was based on the total number pain events and not on the number of participants. It is unclear how many participants were crossed over from the TENS group to the sham TENS group and vice versa. The trial had a high risk of bias regarding random sequence generation and allocation concealment; an unclear risk regarding the blinding of participants and personnel; and a low risk regarding the blinding of the outcome assessors and selective outcome reporting. The trial was small and of very low quality; furthermore, given the issue with trial design we were unable to quantitatively analyse the data. Therefore, we present only a narrative summary and caution is advised in interpreting the results. In relation to our pre-defined primary outcomes, the included trial did not report pain relief at two to four weeks post intervention. The trial authors reported that no difference was found in the changes in pain ratings (recorded at one hour and four hours post intervention) between the TENS and the placebo groups. In relation to our secondary outcomes, the analgesic usage during the trial also did not show any difference between groups. Given the quality of the evidence, we are uncertain whether TENS improves overall satisfaction as compared to sham TENS. The ability to cope with activities of daily living was not evaluated. Regarding adverse events, although one case of itching was reported in the TENS group, the site and nature of itching was not clearly stated; hence it cannot be clearly attributed to TENS. Also, two participants receiving 'sham' TENS reported a worsening of pain with the intervention. AUTHORS' CONCLUSIONS Since we have only included one small and very low-quality trial, with a high risk of bias across several domains, we are unable to conclude whether TENS is harmful or beneficial for managing pain in people with SCD. There is a need for a well-designed, adequately-powered, RCT to evaluate the role of TENS in managing pain in people with SCD.
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Affiliation(s)
- Sudipta Pal
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of Community MedicineJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Ruchita Dixit
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of Community MedicineJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Soe Moe
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of Community MedicineJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Myron Anthony Godinho
- University of New South WalesSchool of Public Health and Community MedicineKensingtonNSWAustralia2052
| | - Adinegara BL Abas
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of Community MedicineJalan Batu HamparBukit BaruMelakaMalaysia75150
| | - Samir K Ballas
- Jefferson Medical College, Thomas Jefferson UniversityCardeza Foundation for Hematologic Research, Department of Medicine1015 Walnut StreetPhiladelphiaPAUSA19107‐5099
| | - Shanker Ram
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of PsychiatryJalan Batu Hampar, Bukit BaruMelakaMelakaMalaysia75150
| | - Uduman Ali M Yousuf
- Melaka‐Manipal Medical College (Manipal Academy of Higher Education)Department of MedicineJalan Batu Hampar, Bukit BaruMelakaMelakaMalaysia75150
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Renedo A, Miles S, Chakravorty S, Leigh A, Telfer P, Warner JO, Marston C. Not being heard: barriers to high quality unplanned hospital care during young people's transition to adult services - evidence from 'this sickle cell life' research. BMC Health Serv Res 2019; 19:876. [PMID: 31752858 PMCID: PMC6873494 DOI: 10.1186/s12913-019-4726-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 11/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Young people’s experiences of healthcare as they move into adult services can have a major impact on their health, and the transition period for young people with sickle cell disease (SCD) needs improvement. In this study, we explore how young people with SCD experience healthcare during this period of transition. Methods We conducted a co-produced longitudinal qualitative study, including 80 interviews in 2016–2017 with young people with SCD aged 13–21 (mean age 16.6) across two cities in England. We recruited 48 participants (30 female, 18 male): 27 interviews were one-off, and 53 were repeated 2–3 times over approximately 18 months. We used an inductive analytical approach, combining elements of Grounded Theory and thematic analysis. Results Participants reported significant problems with the care they received in A&E during painful episodes, and in hospital wards as inpatients during unplanned healthcare. They experienced delays in being given pain relief and their basic care needs were not always met. Participants said that non-specialist healthcare staff did not seem to know enough about SCD and when they tried to work with staff to improve care, staff often seemed not prepared to listen to them or act on what they said. Participants said they felt out of place in adult wards and uncomfortable with the differences in adult compared with paediatric wards. Because of their experiences, they tried to avoid being admitted to hospital, attempting to manage their painful episodes at home and accessing unplanned hospital care only as a last resort. By contrast, they did not report having problems within SCD specialist services during planned, routine care. Conclusions Our study underscores the need for improvements to make services youth-friendly and youth-responsive, including training staff in SCD-specific care, compassionate care and communication skills that will help them elicit and act on young people’s voices to ensure they are involved in shaping their own healthcare. If young people are prevented from using transition skills (self-management, self-advocacy), or treated by staff who they worry do not have enough medical competency in their condition, they may well lose their trust in services, potentially compromising their own health.
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Affiliation(s)
- Alicia Renedo
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sam Miles
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Andrea Leigh
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John O Warner
- Collaborations for Leadership in Applied Health Research and Care NW London, Imperial College London, London, UK
| | - Cicely Marston
- London School of Hygiene and Tropical Medicine, London, UK.
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Cooper TE, Hambleton IR, Ballas SK, Cashmore BA, Wiffen PJ. Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults. Cochrane Database Syst Rev 2019; 2019:CD012187. [PMID: 31742673 PMCID: PMC6863096 DOI: 10.1002/14651858.cd012187.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is a group of inherited disorders of haemoglobin (Hb) structure in a person who has inherited two mutant globin genes (one from each parent), at least one of which is always the sickle mutation. It is estimated that between 5% and 7% of the world's population are carriers of the mutant Hb gene, and SCD is the most commonly inherited blood disorder. SCD is characterized by distorted sickle-shaped red blood cells. Manifestations of the disease are attributed to either haemolysis (premature red cell destruction) or vaso-occlusion (obstruction of blood flow, the most common manifestation). Shortened lifespans are attributable to serious comorbidities associated with the disease, including renal failure, acute cholecystitis, pulmonary hypertension, aplastic crisis, pulmonary embolus, stroke, acute chest syndrome, and sepsis. Vaso-occlusion can lead to an acute, painful crisis (sickle cell crisis, vaso-occlusive crisis (VOC) or vaso-occlusive episode). Pain is most often reported in the joints, extremities, back or chest, but it can occur anywhere and can last for several days or weeks. The bone and muscle pain experienced during a sickle cell crisis is both acute and recurrent. Key pharmacological treatments for VOC include opioid analgesics, non-opioid analgesics, and combinations of drugs. Non-pharmacological approaches, such as relaxation, hypnosis, heat, ice and acupuncture, have been used in conjunction to rehydrating the patient and reduce the sickling process. OBJECTIVES To assess the analgesic efficacy and adverse events of pharmacological interventions to treat acute painful sickle cell vaso-occlusive crises in adults, in any setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) via the Cochrane Register of Studies Online, MEDLINE via Ovid, Embase via Ovid and LILACS, from inception to September 2019. We also searched the reference lists of retrieved studies and reviews, and searched online clinical trial registries. SELECTION CRITERIA Randomized, controlled, double-blind trials of pharmacological interventions, of any dose and by any route, compared to placebo or any active comparator, for the treatment (not prevention) of painful sickle cell VOC in adults. DATA COLLECTION AND ANALYSIS Three review authors independently assessed studies for eligibility. We planned to use dichotomous data to calculate risk ratio (RR) and number needed to treat for one additional event, using standard methods. Our primary outcomes were participant-reported pain relief of 50%, or 30%, or greater; Patient Global Impression of Change (PGIC) very much improved, or much or very much improved. Our secondary outcomes included adverse events, serious adverse events, and withdrawals due to adverse events. We assessed GRADE and created three 'Summary of findings' tables. MAIN RESULTS We included nine studies with data for 638 VOC events and 594 participants aged 17 to 42 years with SCD presenting to a hospital emergency department in a painful VOC. Three studies investigated a non-steroidal anti-inflammatory drug (NSAID) compared to placebo. One study compared an opioid with a placebo, two studies compared an opioid with an active comparator, two studies compared an anticoagulant with a placebo, and one study compared a combination of three drugs with a combination of four drugs. Risk of bias across the nine studies varied. Studies were primarily at an unclear risk of selection, performance, and detection bias. Studies were primarily at a high risk of bias for size with fewer than 50 participants per treatment arm; two studies had 50 to 199 participants per treatment arm (unclear risk). Non-steroidal anti-inflammatory drugs (NSAID) compared with placebo No data were reported regarding participant-reported pain relief of 50% or 30% or greater. The efficacy was uncertain regarding PGIC very much improved, and PGIC much or very much improved (no difference; 1 study, 21 participants; very low-quality evidence). Very low-quality, uncertain results suggested similar rates of adverse events across both the NSAIDs group (16/45 adverse events, 1/56 serious adverse events, and 1/56 withdrawal due to adverse events) and the placebo group (19/45 adverse events, 2/56 serious adverse events, and 1/56 withdrawal due to adverse events). Opioids compared with placebo No data were reported regarding participant-reported pain relief of 50% or 30%, PGIC, or adverse events (any adverse event, serious adverse events, and withdrawals due to adverse events). Opioids compared with active comparator No data were reported regarding participant-reported pain relief of 50% or 30% or greater. The results were uncertain regarding PGIC very much improved (33% of the opioids group versus 19% of the placebo group). No data were reported regarding PGIC much or very much improved. Very low-quality, uncertain results suggested similar rates of adverse events across both the opioids group (9/66 adverse events, and 0/66 serious adverse events) and the placebo group (7/64 adverse events, 0/66 serious adverse events). No data were reported regarding withdrawal due to adverse events. Quality of the evidence We downgraded the quality of the evidence by three levels to very low-quality because there are too few data to have confidence in results (e.g. too few participants per treatment arm). Where no data were reported for an outcome, we had no evidence to support or refute (quality of the evidence is unknown). AUTHORS' CONCLUSIONS This review identified only nine studies, with insufficient data for all pharmacological interventions for analysis. The available evidence is very uncertain regarding the efficacy or harm from pharmacological interventions used to treat pain related to sickle cell VOC in adults. This area could benefit most from more high quality, certain evidence, as well as the establishment of suitable registries which record interventions and outcomes for this group of people.
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Affiliation(s)
- Tess E Cooper
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
| | - Ian R Hambleton
- Caribbean Institute for Health ResearchChronic Disease Research CentreThe University of the West IndiesJemotts LaneBridgetownBarbadosBB11115
| | - Samir K Ballas
- Jefferson Medical College, Thomas Jefferson UniversityCardeza Foundation for Hematologic Research, Department of Medicine1015 Walnut StreetPhiladelphiaPAUSA19107‐5099
| | - Brydee A Cashmore
- The University of Sydney and The Children's Hospital at WestmeadCentre for Kidney ResearchSydneyAustralia
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Carden MA, Brousseau DC, Ahmad FA, Bennett J, Bhatt S, Bogie A, Brown K, Casper TC, Chapman LL, Chumpitazi CE, Cohen D, Dampier C, Ellison AM, Grasemann H, Hickey RW, Hsu LL, Leibovich S, Powell E, Richards R, Sarnaik S, Weiner DL, Morris CR. Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso-occlusive pain. Am J Hematol 2019; 94:689-696. [PMID: 30916794 DOI: 10.1002/ajh.25471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
Vaso-occlusive pain events (VOE) are the leading cause of emergency department (ED) visits in sickle cell anemia (SCA). This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four-hundred charts of children age 3-21 years with SCA/VOE receiving parenteral opioids at 20 high-volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 ± 4.9 years; 46% were male; 92% had hemoglobin-SS. The IVFs (bolus and/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation-to-ED-disposition was smaller in the NSB group (2.2 vs 3.0, P = .03), while admission rates were higher (71% vs 59%, P = .01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to >50% of children with SCA/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality.
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Affiliation(s)
- Marcus A. Carden
- Departments of Pediatrics and MedicineUniversity of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina
| | - David C. Brousseau
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical College of Wisconsin Milwaukee Wisconsin
| | - Fahd A. Ahmad
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine St. Louis Missouri
| | - Jonathan Bennett
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Alfred I. DuPont Hospital for Children Wilmington Delaware
| | - Seema Bhatt
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center Cincinnati Ohio
| | - Amanda Bogie
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | - Kathleen Brown
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's National Medical Center Washington District of Columbia
| | - Theron Charles Casper
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah Salt Lake City Utah
| | | | - Corrie E. Chumpitazi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine Houston Texas
| | - Daniel Cohen
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Nationwide Children's Hospital Columbus Ohio
| | - Carlton Dampier
- Department of Pediatrics, Division of Hematology/OncologyEmory University School of Medicine Atlanta Georgia
- Department of Pediatrics, Division of Pediatric Emergency Medicine, The Aflac Cancer and Blood Disorders Center of Children's Healthcare Atlanta Georgia
| | - Angela M. Ellison
- Department of Pediatrics, Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Hartmut Grasemann
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children Toronto Ontario Canada
| | - Robert W. Hickey
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
| | - Lewis L. Hsu
- Department of Pediatrics, Division of Pediatric Hematology and OncologyUniversity of Illinois at Chicago Chicago Illinois
| | - Sara Leibovich
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UCSF‐Benioff Children's Hospital at Oakland Oakland California
| | - Elizabeth Powell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Rachel Richards
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah Salt Lake City Utah
| | - Syana Sarnaik
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Michigan Detroit Michigan
| | - Debra L. Weiner
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Children's Hospital Boston Massachusetts
| | - Claudia R. Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Abstract
: Sickle cell disease (SCD) is an autosomal recessive genetic condition that alters the shape and function of the hemoglobin molecule in red blood cells. While the overall survival rate among children with SCD has improved in recent years, pediatric rates of hospitalization, ED use, and mortality from complications of SCD remain high. Among patients ages 18 and older, hospital admission and ED usage are even greater-and the median age at death of people with SCD is considerably lower than that of the general population. Nurses who care for patients with SCD have an opportunity to improve health outcomes and quality of life for these patients by recognizing the major SCD-associated complications and providing patients and their caregivers with appropriate educational information. The authors discuss the genetic, hematologic, and clinical features of SCD and describe the major associated health complications. In addition, they review the nursing implications of each complication and provide online links to resources for clinicians, patients, and caregivers.
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Affiliation(s)
- Paula Tanabe
- Paula Tanabe is a professor in the Schools of Nursing and Medicine and associate dean for research development and data science at Duke University, Durham, NC. Regena Spratling is the associate dean and chief academic officer for nursing in the Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta. Dana Smith is a clinical nurse II in the ICU, and Peyton Grissom is the clinical team lead on a general medicine step-down unit, both at Duke University Hospital, Durham, NC. Mary Hulihan is a health scientist in the Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta. Contact author: Mary Hulihan, . The authors and planners have disclosed no potential conflicts of interest, financial or otherwise
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Karafin MS, Chen G, Wandersee NJ, Brandow AM, Hurley RW, Simpson P, Ward D, Li SJ, Field JJ. Chronic pain in adults with sickle cell disease is associated with alterations in functional connectivity of the brain. PLoS One 2019; 14:e0216994. [PMID: 31107926 PMCID: PMC6527293 DOI: 10.1371/journal.pone.0216994] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 05/02/2019] [Indexed: 12/21/2022] Open
Abstract
Chronic pain affects 50% of adults with sickle cell disease (SCD). Although central sensitization is thought to contribute to the pathogenesis of this chronic pain, no studies have examined differences in functional connectivity of the brain between patients with SCD with and without chronic pain. We performed an observational cohort study using resting-state functional MRI (rsfMRI) of the brain on adults with SCD with and without chronic pain. We tested the hypothesis that, compared to those without chronic pain, those with chronic pain would have differences in functional connectivity between the periaqueductal grey (PAG) and other regions of the brain. Twenty-two adults with SCD, 15 with chronic pain and 7 without chronic pain, as well as 10 African-American controls, underwent rsfMRI of the brain. When SCD patients with chronic pain were compared to those without chronic pain, significant differences in connectivity were noted between the PAG and 9 regions of the brain, including several in the default mode network, a network involved in introspection that has been implicated in other chronic pain syndromes. Changes in functional connectivity between patients with SCD with and without chronic pain suggest a mechanism for chronic pain that involves neuro-plastic changes to the brain.
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Affiliation(s)
- Matthew S. Karafin
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
- * E-mail:
| | - Guangyu Chen
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Nancy J. Wandersee
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Amanda M. Brandow
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Robert W. Hurley
- Department of Anesthesia, Wake Forest School of Medicine, Winston Salem, North Carolina, United States of America
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Doug Ward
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Shi-Jiang Li
- Department of Biophysics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Joshua J. Field
- Medical Sciences Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin, United States of America
- Department of Hematology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
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23
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Williams H, Silva RNS, Cline D, Freiermuth C, Tanabe P. Social and Behavioral Factors in Sickle Cell Disease: Employment Predicts Decreased Health Care Utilization. J Health Care Poor Underserved 2019; 29:814-829. [PMID: 29805142 DOI: 10.1353/hpu.2018.0060] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
THE PURPOSE to determine frequency of health care encounters among people with sickle cell disease (SCD) seeking treatment for a vaso-occlusive crisis (VOC). Health care encounters are categorized by visit type (day hospital, ED visit, hospitalization), prevalence of self-reported behavioral and social factors, and any associations between behavioral and social factors and health care encounters. Ninety-five people with SCD were enrolled in a prospective descriptive study in North Carolina. Patients were interviewed concerning behavioral-social factors, and a report of health care encounters was produced, generated by ICD codes associated with VOCs between October 2011 and March 2014. Among 95 patients, there were a total of 839 day hospital and 1,990 ED visits, and 1,101 hospital admissions. Prevalent behavioral and social factors were depression (29%), anxiety (34%), illicit drug use (6%); unstable home situation (17%); and unemployment (81%). Employment and stable home were significantly associated with decreased frequency of health care encounters.
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24
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Chemokine (c-c motif) receptor 2 mediates mechanical and cold hypersensitivity in sickle cell disease mice. Pain 2019; 159:1652-1663. [PMID: 29697532 DOI: 10.1097/j.pain.0000000000001253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Approximately one-third of individuals with sickle cell disease (SCD) develop chronic pain. This debilitating pain is inadequately treated because the underlying mechanisms driving the pain are poorly understood. In addition to persistent pain, patients with SCD are also in a tonically proinflammatory state. Previous studies have revealed that there are elevated plasma levels of many inflammatory mediators including chemokine (c-c motif) ligand 2 (CCL2) in individuals with SCD. Using a transgenic mouse model of SCD, we investigated the contributions of CCL2 signaling to SCD-related pain. Inhibition of chemokine receptor 2 (CCR2), but not CCR4, alleviated the behavioral mechanical and cold hypersensitivity in SCD. Furthermore, acute CCR2 blockade reversed both the behavioral and the in vitro responsiveness of sensory neurons to an agonist of TRPV1, a neuronal ion channel previously implicated in SCD pain. These results provide insight into the immune-mediated regulation of hypersensitivity in SCD and could inform future development of analgesics or therapeutic measures to prevent chronic pain.
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25
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Jhun EH, Sadhu N, Hu X, Yao Y, He Y, Wilkie DJ, Molokie RE, Wang ZJ. Beta2-Adrenergic Receptor Polymorphisms and Haplotypes Associate With Chronic Pain in Sickle Cell Disease. Front Pharmacol 2019; 10:84. [PMID: 30837870 PMCID: PMC6390066 DOI: 10.3389/fphar.2019.00084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/21/2019] [Indexed: 12/29/2022] Open
Abstract
Pain in sickle cell disease (SCD) is severe, variable, and inadequately comprehended. The β2-adrenergic receptor (ADRB2) is critical in mediating neurotransmitter response in the sympathetic nervous system. In this association study, we examined 16 single nucleotide polymorphisms (SNPs) covering 5'-UTR and coding regions of ADRB2 for pain variability in SCD. Subjects recorded their non-crisis, baseline pain experience on a computerized tool from which we obtained chronic pain measurement score- composite pain index (CPI). Regression models yielded significant associations between chronic pain and seven SNPs. Non-synonymous SNP rs1042713 A allele (Arg16) caused a 5.73-fold decrease in CPI (p = 0.002). Allele A of rs12654778 and T of rs17778257 reduced CPI by a fold of 4.52 (p = 0.019), and 4.39 (p = 0.032), respectively. Whereas, in the 5' UTR, allele C of rs1042711, G of rs11168070, C of rs11959427, and C of rs1801704 increased CPI by a fold of 10.86 (p = 0.00049), 5.99 (p = 0.016), 5.69 (p = 0.023), and 5.26 (p = 0.031), respectively. Together, these SNPs accounted for 2-15% of CPI variance after adjusting for covariates. Moreover, these SNPs were in high linkage disequilibrium (LD) showing three LD blocks in our cohort. A 10-marker haplotype increased CPI by 11.5-fold (p = 0.000407). Thus, ADRB2 polymorphisms might contribute to chronic pain severity and heterogeneity in SCD.
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Affiliation(s)
- Ellie H. Jhun
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Nilanjana Sadhu
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Xiaoyu Hu
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
| | - Yingwei Yao
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Ying He
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, United States
| | - Diana J. Wilkie
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, United States
| | - Robert E. Molokie
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, United States
- Jesse Brown Veteran’s Administration Medical Center, Chicago, IL, United States
- Division of Hematology/Oncology, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, United States
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, IL, United States
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Bhatt RR, Zeltzer LK, Coloigner J, Wood JC, Coates TD, Labus JS. Patients with sickle-cell disease exhibit greater functional connectivity and centrality in the locus coeruleus compared to anemic controls. NEUROIMAGE-CLINICAL 2019; 21:101686. [PMID: 30690419 PMCID: PMC6356008 DOI: 10.1016/j.nicl.2019.101686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/13/2019] [Accepted: 01/20/2019] [Indexed: 01/18/2023]
Abstract
Patients with sickle-cell disease (SCD) have greater resting-state functional connectivity between the locus coeruleus (LC) and dorsolateral prefrontal cortex (dlPFC). Patients with SCD have greater resting state centrality of the LC SCD patients with chronic pain exhibited even greater functional connectivity between the LC and dlPFC. This study supports hyper-connectivity between the LC and PFC is a potential chronic pain generator.
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Affiliation(s)
- Ravi R Bhatt
- UCLA Pediatric Pain and Palliative Care Program, Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Lonnie K Zeltzer
- UCLA Pediatric Pain and Palliative Care Program, Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie Coloigner
- Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA, USA; Childrens Hospital Los Angeles, Department of Cardiology, Los Angeles, CA, USA
| | - John C Wood
- Childrens Hospital Los Angeles, Department of Radiology, Los Angeles, CA, USA; Childrens Hospital Los Angeles, Department of Cardiology, Los Angeles, CA, USA
| | - Tom D Coates
- Childrens Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles (CCCBD), Los Angeles, CA, USA
| | - Jennifer S Labus
- Center for Neurobiology of Stress and Resilience, Department of Medicine, Vatche and Tamar Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Abstract
OBJECTIVES Sickle cell disease is the most common hemoglobin variant in the world and can present with recurrent vaso-occlusive painful crises. Pain control in these patients is often difficult and requires a multimodal approach. In patients with uncontrolled pain after traditional pain control methods, ketamine infusions have proven beneficial. Unfortunately, no source alone had described ketamine infusions for pediatric sickle cell patients. Our objective was to provide a thorough definitive reference for health care providers regarding the use of ketamine infusion for pain control in pediatric sickle cell painful crises. METHODS Literature review. RESULTS Low-dose ketamine infusions for pediatric patients with sickle cell disease painful crises resulted in improved pain scores and reduced opioid usage. CONCLUSIONS Ketamine infusions have shown promise in assisting physicians in appropriately treating pediatric sickle cell painful crises.
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Field JJ, Ballas SK, Campbell CM, Crosby LE, Dampier C, Darbari DS, McClish DK, Smith WR, Zempsky WT. AAAPT Diagnostic Criteria for Acute Sickle Cell Disease Pain. THE JOURNAL OF PAIN 2018; 20:746-759. [PMID: 30578848 DOI: 10.1016/j.jpain.2018.12.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/14/2022]
Abstract
Acute pain episodes are the most common complication in patients with sickle cell disease (SCD). Classically attributed to vaso-occlusion, recent insights suggest that chronic pain may also contribute to the pathogenesis of acute pain episodes, which adds complexity to their diagnosis and management. A taxonomy, or classification system, for acute pain in patients with SCD would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including SCD. To accomplish this, a working group of experts in SCD and pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact/functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific to SCD. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of chronic pain, are proposed to define the types of acute pain observed in patients with SCD. PERSPECTIVE: This article presents a taxonomy for acute pain in patients with SCD. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients with SCD.
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Affiliation(s)
- Joshua J Field
- JJF Medical Sciences Institute, BloodCenter of Wisconsin, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Samir K Ballas
- SKB Department of Medicine,Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Claudia M Campbell
- CCM Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lori E Crosby
- LEC Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlton Dampier
- CD Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Deepika S Darbari
- DSD Division of Hematology, Children's National Medical Center, Washington, DC
| | - Donna K McClish
- DKM Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Wally R Smith
- WRS Department of Medicine, Virginia Commonwealth University Health System, Richmond, Virginia
| | - William T Zempsky
- WTZ Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut
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29
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Uwaezuoke SN, Ayuk AC, Ndu IK, Eneh CI, Mbanefo NR, Ezenwosu OU. Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management. J Pain Res 2018; 11:3141-3150. [PMID: 30588066 PMCID: PMC6294061 DOI: 10.2147/jpr.s185582] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain. Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants - either singly or in combination - depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia.
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Affiliation(s)
- Samuel N Uwaezuoke
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria,
| | - Adaeze C Ayuk
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria,
| | - Ikenna K Ndu
- Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Chizoma I Eneh
- Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Ngozi R Mbanefo
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria,
| | - Osita U Ezenwosu
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria,
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30
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Coates TD, Chalacheva P, Zeltzer L, Khoo MC. Autonomic nervous system involvement in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:251-262. [DOI: 10.3233/ch-189011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thomas D. Coates
- Section of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lonnie Zeltzer
- Department of Pediatrics, Pediatric Pain and Palliative Care Program Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Michael C.K. Khoo
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
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31
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Ezenwa MO, Molokie RE, Wang ZJ, Yao Y, Suarez ML, Dyal B, Abudawood K, Wilkie DJ. Differences in Sensory Pain, Expectation, and Satisfaction Reported by Outpatients with Cancer or Sickle Cell Disease. Pain Manag Nurs 2018; 19:322-332. [PMID: 29501359 DOI: 10.1016/j.pmn.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/18/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) report pain scores that appear greater than those reported in a meta-analysis for patients with cancer, but statistical comparisons of the pain scores from both populations have not been published. AIMS The goal of the study described here was to compare pain outcomes reported by outpatients with cancer or SCD. DESIGN Descriptive comparative study. SETTING Outpatient oncology or sickle cell clinics. SUBJECTS The participants were outpatients (N = 415) from three studies: (1) 106 patients with SCD, 93% African-American (referent group); (2) 140 patients with cancer, 90% Caucasian (race discordant); (3) 169 patients with cancer, 20% Caucasian, 65% African-American (race concordant). METHODS Patients completed the PAINReportIt including pain location, quality, pattern, intensity, expectation, satisfaction, and demographic questions. Analyses included the χ2 test, analysis of variance, and regression. RESULTS Outpatients with SCD reported more pain location sites than the race-discordant (p < .001) and race-concordant (p < .001) cancer groups; higher pain quality than the race-discordant (p < .001) and race-concordant (p < .001) groups; and greater pain pattern scores than the race-discordant (p < .001) and race-concordant (p < .001) groups. The race-concordant group reported higher worst pain intensity than the SCD (p < .001) and race-discordant (p = .002) groups. The three groups did not differ significantly on pain expectation (p = .06). Regarding satisfaction with pain level, there was a significant difference between the race-concordant and SCD (p = .006) groups, but not between the race-discordant and SCD (p = .12) groups or between the race-discordant and race-concordant (p = .49) groups. CONCLUSIONS Outpatients with SCD reported three of four sensory pain parameters that were greater than those reported by outpatients with cancer. A better understanding of these differences is pertinent to improving pain outcomes.
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Affiliation(s)
- Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Robert E Molokie
- College of Medicine, College of Pharmacy, and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois; Jesse Brown VA Medical Center, Chicago, Illinois
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, Cancer Center and Comprehensive Sickle Cell Center, University of Illinois, Chicago, Illinois
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Marie L Suarez
- Department of Biobehavioral Health Science (MC 802), University of Illinois at Chicago, College of Nursing, Chicago, Illinois
| | - Brenda Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Khulud Abudawood
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida.
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Yang F, Banerjee T, Narine K, Shah N. Improving Pain Management in Patients with Sickle Cell Disease from Physiological Measures Using Machine Learning Techniques. ACTA ACUST UNITED AC 2018; 7-8:48-59. [PMID: 30906841 DOI: 10.1016/j.smhl.2018.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Pain management is a crucial part in Sickle Cell Disease treatment. Accurate pain assessment is the first stage in pain management. However, pain is a subjective response and hard to assess via objective approaches. In this paper, we proposed a system to map objective physiological measures to subjective self-reported pain scores using machine learning techniques. Using Multinomial Logistic Regression and data from 40 patients, we were able to predict patients' pain scores on an 11-point rating scale with an average accuracy of 0.578 at the intra-individual level, and an accuracy of 0.429 at the inter-individual level. With a condensed 4-point rating scale, the accuracy at the inter-individual level was further improved to 0.681. Overall, we presented a preliminary machine learning model that can predict pain scores in SCD patients with promising results. To our knowledge, such a system has not been proposed earlier within the SCD or pain domains by exploiting machine learning concepts within the clinical framework.
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Affiliation(s)
- Fan Yang
- Department of Computer Science and Engineering, Wright State University, OH 45435, USA
| | - Tanvi Banerjee
- Department of Computer Science and Engineering, Wright State University, OH 45435, USA
| | - Kalindi Narine
- Department of Pediatrics, Division of Hematology and Oncology, Duke University Hospital, NC 27710, USA
| | - Nirmish Shah
- Division of Hematology, Department of Medicine, Duke University, NC 27710, USA
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33
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Utility of Non-Invasive Monitoring of Cardiac Output and Cerebral Oximetry during Pain Management of Children with Sickle Cell Disease in the Pediatric Emergency Department. CHILDREN-BASEL 2018; 5:children5020017. [PMID: 29382114 PMCID: PMC5835986 DOI: 10.3390/children5020017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/31/2017] [Accepted: 01/04/2018] [Indexed: 11/23/2022]
Abstract
Pain crisis in children with sickle cell disease (SCD) is typically managed with intravenous fluids and parenteral opioids in the pediatric emergency department. Electrical cardiometry (EC) can be utilized to measure cardiac output (CO) and cardiac index (CI) non-invasively. Near-infrared spectroscopy (NIRS) measuring cerebral (rCO2) and splanchnic regional (rSO2) mixed venous oxygenation non-invasively has been utilized for monitoring children with SCD. We studied the value and correlation of NIRS and EC in monitoring hemodynamic status in children with SCD during pain crisis. We monitored EC and NIRS continuously for 2 h after presentation and during management. Forty-five children participated in the study. CO (D = 1.72), CI (D = 1.31), rSO2 (D = 11.6), and rCO2 (D = 9.3), all increased over time. CO max and CI max were achieved 1 h after starting resuscitation. rCO2 max attainment was quicker than rSO2, as monitored by NIRS. CI max correlated with rCO2 max (r = −0.350) and rSO2 max (r = −0.359). In adjustment models, initial CI significantly impacted initial rCO2 (p = 0.045) and rCO2 max (p = 0.043), while initial CO impacted rCO2 max (p = 0.030). Cardiac output monitoring and NIRS monitoring for cerebral and splanchnic oxygenation were feasible and improved the monitoring of therapeutic interventions for children with SCD during pain crisis.
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34
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Peterson SE, Selvaggi KJ, Scullion BF, Blinderman CD. Pain Management and Antiemetic Therapy in Hematologic Disorders. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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35
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Saunthararajah Y, Vichinsky EP. Sickle Cell Disease. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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36
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Lopes TDS, Silva WDS, Ribeiro SB, Figueiredo CA, Campbell FQ, Daltro GDC, Valenzuela A, Montoya P, Lucena RDCS, Baptista AF. Does Transcranial Direct Current Stimulation Combined with Peripheral Electrical Stimulation Have an Additive Effect in the Control of Hip Joint Osteonecrosis Pain Associated with Sickle Cell Disease? A Protocol for a One-Session Double Blind, Block-Randomized Clinical Trial. Front Hum Neurosci 2017; 11:633. [PMID: 29326577 PMCID: PMC5742338 DOI: 10.3389/fnhum.2017.00633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/11/2017] [Indexed: 12/29/2022] Open
Abstract
Chronic pain in Sickle Cell Disease (SCD) is probably related to maladaptive plasticity of brain areas involved in nociceptive processing. Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES) can modulate cortical excitability and help to control chronic pain. Studies have shown that combined use of tDCS and PES has additive effects. However, to date, no study investigated additive effects of these neuromodulatory techniques on chronic pain in patients with SCD. This protocol describes a study aiming to assess whether combined use of tDCS and PES more effectively alleviate pain in patients with SCD compared to single use of each technique. The study consists of a one-session double blind, block-randomized clinical trial (NCT02813629) in which 128 participants with SCD and femoral osteonecrosis will be enrolled. Stepwise procedures will occur on two independent days. On day 1, participants will be screened for eligibility criteria. On day 2, data collection will occur in four stages: sample characterization, baseline assessment, intervention, and post-intervention assessment. These procedures will last ~5 h. Participants will be divided into two groups according to homozygous for S allele (HbSS) (n = 64) and heterozygous for S and C alleles (HbSC) (n = 64) genotypes. Participants in each group will be randomly assigned, equally, to one of the following interventions: (1) active tDCS + active PES; (2) active tDCS + sham PES; (3) sham tDCS + active PES; and (4) sham tDCS + sham PES. Active tDCS intervention will consist of 20 min 2 mA anodic stimulation over the primary motor cortex contralateral to the most painful hip. Active PES intervention will consist of 30 min sensory electrical stimulation at 100 Hz over the most painful hip. The main study outcome will be pain intensity, measured by a Visual Analogue Scale. In addition, electroencephalographic power density, cortical maps of the gluteus maximus muscle elicited by Transcranial Magnetic Stimulation (TMS), serum levels of Brain-derived Neurotrophic Factor (BDNF), and Tumor Necrosis Factor (TNF) will be assessed as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.
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Affiliation(s)
- Tiago da Silva Lopes
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil.,Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Wellington Dos Santos Silva
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil.,Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.,Health Section, Adventist Faculty of Bahia, Cachoeira, Brazil
| | - Sânzia B Ribeiro
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil.,Health Section, Adventist Faculty of Bahia, Cachoeira, Brazil
| | | | - Fernanda Q Campbell
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil
| | | | | | - Pedro Montoya
- Research Institute of Health Sciences (IUNICS), University of the Balearic Islands, Palma, Spain
| | - Rita de C S Lucena
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil.,Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil
| | - Abrahão F Baptista
- Health and Functionality Study Group, Federal University of Bahia, Salvador, Brazil.,Graduate Program in Medicine and Health, Federal University of Bahia, Salvador, Brazil.,Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Lovett PB, Sule HP, Lopez BL. Sickle Cell Disease in the Emergency Department. Hematol Oncol Clin North Am 2017; 31:1061-1079. [DOI: 10.1016/j.hoc.2017.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Khaleel M, Puliyel M, Shah P, Sunwoo J, Kato RM, Chalacheva P, Thuptimdang W, Detterich J, Wood JC, Tsao J, Zeltzer L, Sposto R, Khoo MCK, Coates TD. Individuals with sickle cell disease have a significantly greater vasoconstriction response to thermal pain than controls and have significant vasoconstriction in response to anticipation of pain. Am J Hematol 2017; 92:1137-1145. [PMID: 28707371 DOI: 10.1002/ajh.24858] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 12/17/2022]
Abstract
The painful vaso-occlusive crises (VOC) that characterize sickle cell disease (SCD) progress over hours from the asymptomatic steady-state. SCD patients report that VOC can be triggered by stress, cold exposure, and, pain itself. We anticipated that pain could cause neural-mediated vasoconstriction, decreasing regional blood flow and promoting entrapment of sickle cells in the microvasculature. Therefore, we measured microvascular blood flow in the fingers of both hands using plethysmography and laser-Doppler flowmetry while applying a series of painful thermal stimuli on the right forearm in 23 SCD patients and 25 controls. Heat pain applied to one arm caused bilateral decrease in microvascular perfusion. The vasoconstriction response started before administration of the thermal pain stimulus in all subjects, suggesting that pain anticipation also causes significant vasoconstriction. The time delay between thermal pain application and global vasoconstriction ranged from 5 to 15.5 seconds and increased with age (P < .01). Although subjective measures, pain threshold and pain tolerance were not different between SCD subjects and controls, but the vaso-reactivity index characterizing the microvascular blood flow response to painful stimuli was significantly higher in SCD patients (P = .0028). This global vasoconstriction increases microvascular transit time, and may promote entrapment of sickle cells in the microvasculature, making vaso-occlusion more likely. The rapidity of the global vasoconstriction response indicates a neural origin that may play a part in the transition from steady-state to VOC, and may also contribute to the variability in VOC frequency observed in SCD patients.
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Affiliation(s)
- Maha Khaleel
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Mammen Puliyel
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Payal Shah
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - John Sunwoo
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Roberta M. Kato
- Division of Pulmonology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | | | - Wanwara Thuptimdang
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Jon Detterich
- Division of Cardiology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - John C. Wood
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
- Division of Cardiology; Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
| | - Jennie Tsao
- Pediatric Pain Program, University of California Los Angeles; Los Angeles California
| | - Lonnie Zeltzer
- Pediatric Pain Program, University of California Los Angeles; Los Angeles California
| | - Richard Sposto
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
- Department of Preventive Medicine, Keck School of Medicine; University of Southern California; Los Angeles California
| | - Michael C. K. Khoo
- Biomedical engineering; Viterbi School of Engineering; Los Angeles California
| | - Thomas D. Coates
- Section of Hematology; Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine; Los Angeles California
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Sins JWR, Mager DJ, Davis SCAT, Biemond BJ, Fijnvandraat K. Pharmacotherapeutical strategies in the prevention of acute, vaso-occlusive pain in sickle cell disease: a systematic review. Blood Adv 2017; 1:1598-1616. [PMID: 29296801 PMCID: PMC5728463 DOI: 10.1182/bloodadvances.2017007211] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/03/2017] [Indexed: 12/17/2022] Open
Abstract
Sickle-cell disease (SCD) is characterized by frequent and painful vaso-occlusive crises (VOCs). Various treatments have been evaluated over the years. However, a clear overview is lacking. The objective of this study was to systematically review all pharmacotherapeutical strategies in the prevention of VOCs beyond hydroxyurea. We performed a systematic literature search (MEDLINE, Embase, CENTRAL). Eligible studies were controlled clinical trials evaluating pharmacotherapeutical interventions targeting the reduction of VOCs in patients with SCD. Primary outcomes were the number or duration of SCD-related pain days, VOCs, or hospital admissions for VOCs. Secondary outcomes included time to first VOC or hospital admission for a VOC. A standardized data extraction sheet was used. The methodological quality of studies was assessed using Cochrane's risk-of-bias tool. A total of 36 studies were included in this review, covering 26 different prophylactic interventions. The most promising interventions for reducing the frequency of either VOCs or hospitalizations were the oral antioxidants l-glutamine and ω-3 fatty acids and the IV antiadhesive agent crizanlizumab. Twenty-three studies did not show any beneficial effect of the intervention under investigation, and 6 studies were either too small or methodologically inadequate to draw conclusions. Because of the heterogeneity of interventions, no meta-analysis was performed. In conclusion, this review identified 3 promising pharmacotherapeutical strategies in the prevention of VOCs in SCD. Importantly, this study highlights the discrepancy between the significant burden of SCD worldwide and the low number of adequate trials performed. This review was registered at PROSPERO (CRD42015025250).
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Affiliation(s)
- Joep W R Sins
- Department of Pediatric Hematology, Emma Children's Hospital, and
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | - David J Mager
- Department of Pediatric Hematology, Emma Children's Hospital, and
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Bart J Biemond
- Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands
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40
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Transcutaneous electrical nerve stimulation (TENS) for pain management in sickle cell disease. Hippokratia 2017. [DOI: 10.1002/14651858.cd012762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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41
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Paz OS, de Jesus Pinheiro M, do Espirito Santo RF, Villarreal CF, Castilho MS. Nanomolar anti-sickling compounds identified by ligand-based pharmacophore approach. Eur J Med Chem 2017; 136:487-496. [DOI: 10.1016/j.ejmech.2017.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/10/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
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Okomo U, Meremikwu MM. Fluid replacement therapy for acute episodes of pain in people with sickle cell disease. Cochrane Database Syst Rev 2017; 7:CD005406. [PMID: 28759112 PMCID: PMC6483538 DOI: 10.1002/14651858.cd005406.pub5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Treating vaso-occlusive painful crises in people with sickle cell disease is complex and requires multiple interventions. Extra fluids are routinely given as adjunct treatment, regardless of the individual's state of hydration with the aim of slowing or stopping the sickling process and thereby alleviating pain. This is an update of a previously published Cochrane Review. OBJECTIVES To determine the optimal route, quantity and type of fluid replacement for people with sickle cell disease with acute painful crises. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings.We also conducted searches of Embase (November 2007), LILACS, www.ClinicalTrials.gov (05 January 2010), and the WHO ICTRP (30 June 2017).Date of most recent search of the Group's Haemoglobinopathies Trials Register: 16 February 2017. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared the administration of supplemental fluids adjunctive to analgesics by any route in people with any type of sickle cell disease during an acute painful episode, under medical supervision (inpatient, day care or community). DATA COLLECTION AND ANALYSIS No relevant trials have yet been identified. MAIN RESULTS Sixteen trials were identified by the searches, all of which were not eligible for inclusion in the review. AUTHORS' CONCLUSIONS Treating vaso-occlusive crises is complex and requires multiple interventions. Extra fluids, generally oral or intravenous, are routinely administered during acute painful episodes to people with sickle cell disease regardless of the individual's state of hydration. Reports of their use during these acute painful episodes do not state the efficacy of any single route, type or quantity of fluid compared to another. However, there are no randomised controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid. This systematic review identifies the need for a multicentre randomised controlled trial assessing the efficacy and possible adverse effects of different routes, types and quantities of fluid administered to people with sickle cell disease during acute painful episodes.
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Affiliation(s)
- Uduak Okomo
- Vaccine and Immunity Theme, Medical Research Council Unit, The Gambia, Atlantic Boulevard, Fajara, Gambia, P.O. Box 273
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Ballas SK. The Use of Cannabis by Patients with Sickle Cell Disease Increased the Frequency of Hospitalization due to Vaso-Occlusive Crises. Cannabis Cannabinoid Res 2017; 2:197-201. [PMID: 29082316 PMCID: PMC5627667 DOI: 10.1089/can.2017.0011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Introduction: The objective of this study was to determine if patients with sickle cell disease using cannabis had decreased frequency of acute vaso-occlusive crises (VOCs) that required hospitalization. Method: This was a retrospective study in which 270 urine drug screen tests were done on 72 patients: 40 males and 32 females. Results: Cannabinoids were found in 144 urine tests from 37 patients and were negative in 126 tests from 35 patients. Males who used cannabis were significantly younger (p<0.001) than males who did not. Patients who tested positive used benzodiazepines, cocaine, and phencyclidine significantly more often than patients who tested negative. There was no significant difference in the amounts of opioids consumed by users and nonusers of cannabis. The cannabis cohort was seen in the clinic significantly (p<0.05) less often than controls, but hospital admissions were significantly greater in the cannabis group than controls (p<0.05). Conclusion: These data show an unexpected negative effect of cannabis on the frequency of VOCs. This may be due to the effect of cannabis on the brain and/or the severity of the disease in the cannabis users. More controlled studies are needed to clarify these findings.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation for Hematologic Research, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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44
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AAPT Diagnostic Criteria for Chronic Sickle Cell Disease Pain. THE JOURNAL OF PAIN 2017; 18:490-498. [DOI: 10.1016/j.jpain.2016.12.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 12/14/2016] [Accepted: 12/20/2016] [Indexed: 12/11/2022]
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Correia CR, Soares AT, Azurara L, Palaré MJ. Use of gabapentin in the treatment of chronic pain in an adolescent with sickle cell disease. BMJ Case Rep 2017; 2017:bcr-2016-218614. [PMID: 28432164 DOI: 10.1136/bcr-2016-218614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaso-occlusive crises are the most common manifestation of sickle cell disease (SCD) and the main cause of hospital admission in these patients. There is emerging evidence that vaso-occlusive pain has both nociceptive and neuropathic components. However, the treatment of SCD-related pain with neuropathic drugs has not yet been systematically studied, particularly in children. We describe a 14-year-old girl with SCD and multiple hospital admissions for pain management for severe acute vaso-occlusive pain episodes. The patient was evaluated by a multidisciplinary team of specialists which considered that the chronic, refractory pain she was experiencing for years was probably neuropathic in origin and it was decided to start oral gabapentin (300 mg/day). At 10 months follow-up, the patient reported remarkable improvement in her quality of life with a significant decrease in the number of hospital admissions (three admissions for acute vaso-occlusive pain episodes in 10 months versus the previously monthly recurrences).
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Affiliation(s)
- Cátia R Correia
- Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Laura Azurara
- Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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46
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van Tuijn CFJ, Sins JWR, Fijnvandraat K, Biemond BJ. Daily pain in adults with sickle cell disease-a different perspective. Am J Hematol 2017; 92:179-186. [PMID: 27880985 DOI: 10.1002/ajh.24612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 02/02/2023]
Abstract
Previous reports demonstrated that patients with sickle cell disease (SCD) experience pain on more than half of the observed days. Yet, these high incidences do not seem to match observations in our population. In this prospective cohort study, we aimed to assess the frequency and characteristics of daily, self-reported pain among adult SCD patients in the Netherlands. Consecutive patients were enrolled during routine outpatient visits and followed up to 6 months. A total of 55 patients completed 5,982 diary observation days. Median age was 27 years (IQR 23-43). Patients reported SCD related pain on 17% of the observed days; on 13% of these days this pain was not defined as a painful crisis, while 3% was reported as a painful crisis but managed at home, and on 1% of the observed days patients were admitted to the hospital. Analgesics were used on 52% of days with pain with a relatively infrequent use of oral opioids (9% of pain days). This first European study on pain in SCD indicates that pain appears to be significantly less frequent in our population as compared to previous study cohorts from the United States, and may be more representative for current SCD populations in other Western countries. Besides a more widespread use of hydroxycarbamide in modern disease management, differences in organization and accessibility of healthcare between countries may also explain this discrepancy.
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Affiliation(s)
| | - Joep W. R. Sins
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Bart J. Biemond
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
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47
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Cooper TE, Hambleton IR, Ballas SK, Wiffen PJ. Pharmacological interventions for painful sickle cell vaso‐occlusive crises in adults. Cochrane Database Syst Rev 2016; 2016:CD012187. [PMCID: PMC6483464 DOI: 10.1002/14651858.cd012187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the analgesic efficacy, and adverse events, of pharmacological interventions used to treat acute painful sickle cell vaso‐occlusive crises in adults, aged 18 and over, in any setting.
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Affiliation(s)
- Tess E Cooper
- Pain Research Unit, Churchill HospitalCochrane Pain, Palliative and Supportive Care GroupChurchill HospitalOxfordUKOX3 7LE
| | - Ian R Hambleton
- Caribbean Institute for Health ResearchChronic Disease Research CentreThe University of the West IndiesJemotts LaneBridgetownBarbadosBB11115
| | - Samir K Ballas
- Jefferson Medical College, Thomas Jefferson UniversityCardeza Foundation for Hematologic Research, Department of Medicine1015 Walnut StreetPhiladelphiaUSAPA 19107‐5099
| | - Philip J Wiffen
- University of OxfordPain Research and Nuffield Department of Clinical Neurosciences (Nuffield Division of Anaesthetics)Pain Research UnitChurchill HospitalOxfordUKOX3 7LE
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48
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Ciribassi RM, Patil CL. “We don't wear it on our sleeve”: Sickle cell disease and the (in)visible body in parts. Soc Sci Med 2016; 148:131-8. [DOI: 10.1016/j.socscimed.2015.11.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 11/22/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022]
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Mulchan SS, Valenzuela JM, Crosby LE, Diaz Pow Sang C. Applicability of the SMART Model of Transition Readiness for Sickle-Cell Disease. J Pediatr Psychol 2015; 41:543-54. [PMID: 26717957 DOI: 10.1093/jpepsy/jsv120] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 11/22/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study aimed to examine the applicability of the Social-ecological Model of Adolescent and Young Adult Readiness to Transition (SMART) model for adolescents and young adults (AYA) with sickle-cell disease (SCD). METHODS 14 AYA with SCD (14-24 years old) and 10 clinical experts (6-20 years of experience) completed semi-structured interviews. AYA completed brief questionnaires. Interviews were coded for themes, which were reviewed to determine their fit within the SMART model. RESULTS Overall, most themes were consistent with the model (e.g., sociodemographics/culture, neurocognition/IQ, etc.). Factors related to race/culture, pain management, health-care navigation skills, societal stigma, and lack of awareness about SCD were salient for AYA with SCD. CONCLUSIONS Findings suggest the SMART model may be appropriate in SCD with the consideration of disease-related stigma. This study is a step toward developing a disease-specific model of transition readiness for SCD. Future directions include the development of a measure of transition readiness for this population.
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Affiliation(s)
| | | | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and
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50
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Jhun EH, Yao Y, He Y, Mack AK, Wilkie DJ, Molokie RE, Wang ZJ. Prevalence of pain-related single nucleotide polymorphisms in patients of African origin with sickle cell disease. Pharmacogenomics 2015; 16:1795-806. [PMID: 26555434 DOI: 10.2217/pgs.15.126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prospective pain genetics research is hindered by a lack of data on the prevalence of polymorphisms in pain-relevant genes for patients with sickle cell disease (SCD). For African-Americans in general, limited information is available in public databases. METHODS We prioritized and examined the genotype and allele frequencies of 115 SNPs from 49 candidate pain genes in 199 adult African-Americans and pediatric patients of African origin with SCD. Analyses were performed and compared with available data from public databases. RESULTS Genotype and allele frequencies of a number of SNPs were found to be different between our cohort and those from the databases and between adult and pediatric subjects. CONCLUSION As pain therapy is inadequate in a significant percentage of patients with SCD, candidate pain genetic studies may aid in designing precision pain medicine. We provide prevalence data as a reference for prospective genetic studies in this population.
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Affiliation(s)
- Ellie H Jhun
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainsville, FL, USA.,Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - A Kyle Mack
- Northwestern University-Feinberg School of Medicine, Division of Pediatric Hematology/Oncology/Stem Cell Transplantation, Children's Memorial Hospital, Chicago, IL, USA
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainsville, FL, USA.,Department of Biobehavioral Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Robert E Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
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