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Opoku‐Agyakwa M, Lawson HJ, Olayemi E. Comparative analysis of opioid use in sickle cell crisis in an urban facility in Ghana. EJHAEM 2023; 4:582-586. [PMID: 37601855 PMCID: PMC10435722 DOI: 10.1002/jha2.704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 08/22/2023]
Abstract
Vaso-occlusive crises (VOC) is common and opioids are the treatment of choice.This study compared parenteral pethidine and morphine in the elimination/reduction of pain in acute VOC to tolerable levels. This open-label randomized study compared intravenous morphine 5 mg 4 hourly to intramuscular pethidine 75 mg 4 hourly. Eighty-two consenting adult sickle cell disease participants were recruited from the Korle-Bu Polyclinic. (Forty-one participants in each arm). There were 42 male and 40 female participants. Median age was 25 years. Pethidine participants totalling 31.7% (13/41) and 53.7% (22/41) in the morphine arm had a sustained response within 6 h, p = 0.027. In the pethidine and morphine arms 60.0% (24/40) and 62.5% (25/40) of participants respectively achieved adequate pain control within 72 h of initiating therapy, p = 0.296. Most participants, 96.3% (79/82) had no side effects to opioids. The commonest side effects were generalized pruritus, nausea and vomiting, and headaches. More pethidine than morphine participants experienced side effects 29.3% and 22.0% respectively; p = 0.448. In conclusion, more morphine participants achieved a sustained pain response compared to the pethidine participants. There was no difference in the tolerability and side effect profile of the opioids. No participant experienced respiratory suppression.
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Affiliation(s)
| | - Henry J. Lawson
- Family Medicine UnitCommunity Health DepartmentUniversity of Ghana Medical SchoolAccraGhana
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Alshahrani MS, AlSulaibikh AH, ElTahan MR, AlFaraj SZ, Asonto LP, AlMulhim AA, AlAbbad MF, Almaghraby N, AlJumaan MA, AlJunaid TO, Darweesh MN, AlHawaj FM, Mahmoud AM, Alossaimi BK, Alotaibi SK, AlMutairi TM, AlSulaiman PharmD DA, Alfaraj D, Alhawwas R, Mbuagbaw L, Lewis K, Verhovsek M, Crowther M, Guyatt G, Alhazzani W. Ketamine administration for acute painful sickle cell crisis: A randomized controlled trial. Acad Emerg Med 2022; 29:150-158. [PMID: 34449939 PMCID: PMC9292870 DOI: 10.1111/acem.14382] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/27/2021] [Accepted: 08/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective was to evaluate the efficacy and safety of single-dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). METHODS This study was a parallel-group, prospective, randomized, double-blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug-related side effects. Authors performed the analysis using intention-to-treat principle. RESULT A total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug-related side effects compared to 2.2% in the morphine group. CONCLUSION Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2-h period and reduced the cumulative morphine dose in the ED with no significant drug-related side effects in the ketamine-treated group.
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Affiliation(s)
- Mohammed S. Alshahrani
- Emergency and Critical Care Departments King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Amal H. AlSulaibikh
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Mohamed R. ElTahan
- Anesthesiology Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Sukayna Z. AlFaraj
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Laila P. Asonto
- Emergency and Critical Care Departments King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Abdullah A. AlMulhim
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Murad F. AlAbbad
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Nisreen Almaghraby
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Mohammed A. AlJumaan
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Thamir O. AlJunaid
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Moath N. Darweesh
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Faisal M. AlHawaj
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Alaa M. Mahmoud
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Bader K. Alossaimi
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Shaikhah K. Alotaibi
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Talal M. AlMutairi
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Duaa A. AlSulaiman PharmD
- Pharmacy Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Dunya Alfaraj
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Reem Alhawwas
- Emergency Department King Fahad Hospital of the University‐Imam Abdulrahman Bin Faisal University Dammam Kingdom of Saudi Arabia
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
| | - Kim Lewis
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | | | - Mark Crowther
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence and Impact McMaster University Hamilton Ontario Canada
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Akaba K, Nwogoh B, Obanife H, Essien O, Epoke E. Prevalence of chronic complications in adult sickle cell anemia patients in a tertiary hospital in South-South Nigeria. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_97_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alshahrani MS, Asonto LP, El Tahan MM, Al Sulaibikh AH, Al Faraj SZ, Al Mulhim AA, Al Abbad MF, Al Nahhash SA, Aldarweesh MN, Mahmoud AM, Almaghraby N, Al Jumaan MA, Al Junaid TO, Al Hawaj FM, AlKenany S, ElSayed OF, Abdelwahab HM, Moussa MM, Alossaimi BK, Alotaibi SK, AlMutairi TM, AlSulaiman DA, Al Shahrani SD, Alfaraj D, Alhazzani W. Study protocol for a randomized, blinded, controlled trial of ketamine for acute painful crisis of sickle cell disease. Trials 2019; 20:286. [PMID: 31133061 PMCID: PMC6537144 DOI: 10.1186/s13063-019-3394-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 05/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is an inherited hematological disorder where the shape of red blood cells is altered, resulting in the destruction of red blood cells, anemia, and other complications. SCD is prevalent in the southern and eastern provinces of the Arabian peninsula. The most common complications for individuals with SCD are acute painful episodes that require several doses of intravenous opioids, making pain control for these individuals challenging. Instead of opioids, some studies have suggested that ketamine might be used for pain control in acute pain episodes of individuals with SCD. This study aims to evaluate whether the addition of ketamine to morphine can achieve better pain control, decreasing the number of repeated doses of opiates. We hypothesize that early administration of ketamine would lead to a more rapid improvement in pain score and lower opioid requirements. METHODS AND ANALYSIS This study will be a prospective, randomized, concealed, blinded, pragmatic parallel group, controlled trial enrolling adult patients with SCD and acute vaso-occlusive crisis pain. All patients will receive standard analgesic therapy during evaluation. Patients randomized to the treatment arm will receive low-dose ketamine (0.3 mg/kg in 0.9% sodium chloride, 100 ml bag) in addition to standard intravenous hydration, while those in the control group will receive a standard dose of morphine (0.1 mg/kg in 0.9% sodium chloride, 100 ml bag) in addition to the standard intravenous hydration. All healthcare providers will be blinded to the treatment arm. Data will be analyzed according to the intention-to-treat principle. The primary outcome is improvement in pain severity using the Numerical Pain Rating Score. TRIAL REGISTRATION Clinicaltrials.gov, NCT03431285 . Registered on 13 February 2018.
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Affiliation(s)
- Mohammed S Alshahrani
- Emergency and Critical Care Departments, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia.
| | - Laila Perlas Asonto
- Emergency and Critical Care Departments, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Mohamed M El Tahan
- Anesthesia Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, Kingdom of Saudi Arabia, Mansoura University, Mansoura, Egypt
| | - Amal H Al Sulaibikh
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Sukayna Z Al Faraj
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Abdullah A Al Mulhim
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Murad F Al Abbad
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Samar A Al Nahhash
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Moath N Aldarweesh
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Alaa M Mahmoud
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Nisreen Almaghraby
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Mohammed A Al Jumaan
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Thamir O Al Junaid
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Faisal M Al Hawaj
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Samar AlKenany
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Omaima F ElSayed
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Haitham M Abdelwahab
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Mohamed M Moussa
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Bader K Alossaimi
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Shaikah K Alotaibi
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Talal M AlMutairi
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Duaa A AlSulaiman
- Pharmacy Department, King Fahad Hospital of the University, AlKhobar, Kingdom of Saudi Arabia
| | - Saad D Al Shahrani
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Donia Alfaraj
- Emergency Department, King Fahad Hospital of the University, Imam Abdulrahman bin Faisal University-Dammam, AlKhobar, Kingdom of Saudi Arabia
| | - Waleed Alhazzani
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Sabrie M, Cannas G, Tazarourte K, Poutrel S, Connes P, Hot A, Renoux C, Fattoum J, Joly P. Drepa-Opia: A Pilot Study to Determine the Predictive Factors of Morphine Use and Consumption in Hospitalized Adult Patients with Sickle Cell Disease. Hemoglobin 2019; 42:217-224. [PMID: 30604640 DOI: 10.1080/03630269.2018.1529602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the clinical, biological and genetic factors that could be associated with the use and dose of morphine during hospitalization for vaso-occlussive crisis (VOC) in adults with sickle cell disease. Ninety-nine hospitalizations for acute VOC (58 sickle cell disease patients aged 18 to 60 years, one to six hospitalizations each) were recorded; we investigated the associations between qualitative and quantitative opioid requirements and several biological, clinical, epidemiological and genetic parameters. Visual analog pain scale (VAS) was the only independent predictor of the qualitative need for morphine (mean value of 8.5 vs. 6.1 for the 77 hospitalizations that required morphine). A higher total administered morphine dose, which relates mainly to the overall crisis severity, was associated with a lower hemoglobin (Hb) level at entry. The mean daily morphine dose, which is more influenced by the individual sensitivity to morphine, was not influenced by the studied genetic parameters [sickle cell disease type, α-thalassemia (α-thal) status, UGT2B7 and ABCB1 genotypes] but a very slight negative association was found with the total bilirubin (BIL) level at entry. Our study demonstrated that physicians are often reluctant to prescribe morphine in sickle cell disease as a VAS of 6 corresponds to the usual threshold of administration in other instances. Total Hb at entry was also associated for the first time with higher total morphine consumption and could be used in a predictive VOC severity score. These results have to be confirmed and completed on larger cohorts.
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Affiliation(s)
- Marie Sabrie
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Giovanna Cannas
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France.,c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France
| | - Karim Tazarourte
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Solène Poutrel
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,e Institut Universitaire de France , Paris , France
| | - Arnaud Hot
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Céline Renoux
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
| | - Jihane Fattoum
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Philippe Joly
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
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Molokie RE, Montminy C, Dionisio C, Farooqui MA, Gowhari M, Yao Y, Suarez ML, Ezenwa MO, Schlaeger JM, Wang ZJ, Wilkie DJ. Opioid doses and acute care utilization outcomes for adults with sickle cell disease: ED versus acute care unit. Am J Emerg Med 2017; 36:88-92. [PMID: 28802541 DOI: 10.1016/j.ajem.2017.07.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/11/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Acute care units (ACUs) with focused sickle cell disease (SCD) care have been shown to effectively address pain and limit hospitalizations compared to emergency departments (ED), the reason for differences in admission rates is understudied. Our aim was compare effects of usual care for adult SCD pain in ACU and ED on opioid doses and discharge pain ratings, hospital admission rates and lengths of stay. METHODS In a retrospective, comparative cohort, single academic tertiary center study, 148 adults with sickle cell pain received care in the ED, ACU or both. From the medical records we documented opioid doses, unit discharge pain ratings, hospital admission rates, and lengths of stay. FINDINGS Pain on admission to the ED averaged 8.7±1.5 and to the ACU averaged 8.0±1.6. The average pain on discharge from the ED was 6.4±3.0 and for the ACU was 4.5±2.5. 70% of the 144 ED visits resulted in hospital admissions as compared to 37% of the 73 ACU visits. Admissions from the ED or ACU had similar inpatient lengths of stay. Significant differences between ED and ACU in first opioid dose and hourly opioid dose were noted. CONCLUSIONS Applying guidelines for higher dosing of opioids for acute painful episodes in adults with SCD in ACU was associated with improved pain outcomes and decreased hospitalizations, compared to ED. Adoption of this approach for SCD pain in ED may result in improved outcomes, including a decrease in hospital admissions.
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Affiliation(s)
- Robert E Molokie
- University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States; Jesse Brown Veterans Administration Medical Center, 820 S. Damen Avenue, MP 111, Chicago, IL 60612, United States; University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States.
| | - Chariz Montminy
- University of Illinois Hospital and Health Sciences System, Department of Nursing, 1740 W. Taylor, Chicago, IL 60614, United States.
| | - Corissa Dionisio
- Riley Hospital for Children at Indiana University Health Department of Psychiatry, 705 Riley Hospital Drive, Indianapolis, IN 46202, United States.
| | | | - Michel Gowhari
- University of Illinois at Chicago, College of Medicine, Department of Hematology/Oncology, 820 S. Wood Street Suite 172 CSN (M/C 712), Chicago, IL 60612, United States.
| | - Yingwei Yao
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
| | - Marie L Suarez
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States.
| | - Miriam O Ezenwa
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
| | - Judith M Schlaeger
- University of Illinois at Chicago, College of Nursing, Department of Women, Children and Family Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States.
| | - Zaijie J Wang
- University of Illinois at Chicago, College of Pharmacy, Department of Biopharmaceutical Sciences, 833 S. Wood Street, Chicago, IL 60612, United States.
| | - Diana J Wilkie
- University of Illinois at Chicago, College of Nursing, Department of Biobehavioral Health Science, 845 S. Damen Avenue, (M/C 802), Chicago, IL 60612, United States; University of Florida, College of Nursing, Department of Biobehavioral Nursing Science, 1225 Center Drive, Room 2203, Gainesville, FL 32610, United States.
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7
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Han J, Saraf SL, Zhang X, Gowhari M, Molokie RE, Hassan J, Alhandalous C, Jain S, Younge J, Abbasi T, Machado RF, Gordeuk VR. Patterns of opioid use in sickle cell disease. Am J Hematol 2016; 91:1102-1106. [PMID: 27466799 PMCID: PMC5072998 DOI: 10.1002/ajh.24498] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 01/18/2023]
Abstract
Pain, the hallmark complication of sickle cell disease (SCD), is largely managed with opioid analgesics in the United States, but comprehensive data regarding the long-term use of opioids in this patient population is lacking. The pain medication prescription records from a cohort of 203 SCD patients were analyzed. Twenty-five percent were not prescribed opioid medications while 47% took only short-acting opioids, 1% took only long-acting opioids, and 27% took a combination of short-acting and long-acting opioids. The median (interquartile range) daily opioid dose was 6.1 mg (1.7-26.3 mg) of oral morphine equivalents, which is lower than the published opioid use among patients with other pain syndromes. The dose of opioids correlated with the number of admissions due to vaso-occlusive crisis (VOC) (r = 0.53, P < 0.001). When the patients were grouped into quartiles based on daily dose opioid use, a logistic regression model showed that history of avascular necrosis (AVN) (OR: 2.87, 95% CI: 1.37-6.02, P = 0.005), 25-OHD levels (OR: 0.59, 95% CI: 0.38-0.93, P = 0.024) and total bilirubin concentration (OR: 0.64, 95% CI: 0.42-0.99, P = 0.043) were independently associated with opioid use quartiles. In conclusion, doses and types of opioid medications used by adult SCD patients vary widely. Our findings implicate AVN and lower vitamin D levels as factors associated with higher opioid use. They also suggest an association of higher bilirubin levels, possibly suggesting higher hemolytic rate, with lower opioid use. Am. J. Hematol. 91:1102-1106, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois.
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
| | - Santosh L Saraf
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Xu Zhang
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michel Gowhari
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Robert E Molokie
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Jesse Brown VA Medical Center, Chicago, Illinois
| | - Joharah Hassan
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Chaher Alhandalous
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Shivi Jain
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jewel Younge
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois
| | - Taimur Abbasi
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep and Allergy Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Victor R Gordeuk
- Comprehensive Sickle Cell Center, Section of Hematology/Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
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8
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Inoue S, Khan I, Mushtaq R, Sanikommu SR, Mbeumo C, LaChance J, Roebuck M. Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease. Ann Hematol 2015; 95:221-5. [PMID: 26611852 DOI: 10.1007/s00277-015-2558-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED's timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007-2008, (2) years 2011-2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study, we believe that a significantly wider use of hydroxyurea by adult patients most likely would reduce their utilization of ED for the purpose of relief of pain, and further pediatric hematologists may be better positioned to increase hydroxyurea adherence by young adult patients, since they have had established rapport with them before transitioning to adult care.
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Affiliation(s)
- Susumu Inoue
- Department of Pediatric Hematology/Oncology, Hurley Children's Hospital, Flint, MI, 48503, USA.
| | - Isra'a Khan
- Community Hospital North, Community Health Network, Indianapolis, IN, USA.
| | - Rao Mushtaq
- Wake Forest Baptist Medical Center, Wake Forest University, Winston Salem, NC, USA.
| | | | - Carline Mbeumo
- Department of Pediatrics, Hurley Children's Hospital, Flint, MI, 48503, USA.
| | - Jenny LaChance
- Department of Research, Hurley Medical Center, Flint, MI, 48503, USA.
| | - Michael Roebuck
- Department of Emergency Medicine, Hurley Medical Center, Flint, MI, 48503, USA.
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9
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Glassberg J, Simon J, Patel N, Jeong JM, McNamee JJ, Yu G. Derivation and preliminary validation of a risk score to predict 30-day ED revisits for sickle cell pain. Am J Emerg Med 2015; 33:1396-401. [PMID: 26283616 DOI: 10.1016/j.ajem.2015.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Emergency department (ED) revisits and 30-day readmissions have been proposed as markers for quality of ED care for sickle cell disease (SCD). OBJECTIVE To create a scoring system that quantifies the risk of 30-day revisit after ED discharge for SCD vaso-occlusive pain METHODS This was a dual-center retrospective derivation and validation cohort study. The derivation was performed at an academic, tertiary care center and the validation at an urban community hospital. The primary outcome was revisit to the ED within 30 days after an ED discharge for SCD pain. Recursive partitioning was used to derive a scoring system to predict 30-day revisits. RESULTS Of a total of 1456 ED visits for SCD pain, there were 680 ED discharges (admission rate of 53%) in 193 unique individuals included in the derivation cohort. There were 240 (35.3%) 30-day revisits. Of a total of 126 ED visits for SCD, there were 79 ED discharges in 41 unique individuals in the validation cohort. The final risk score included 4 variables: (1) age, (2) insurance status, (3) triage pain score, and (4) amount of opioids administered during the ED visit. Possible scores range from 0 to 6. The areas under the receiver operating characteristic curves were 0.746 (95% confidence interval, 0.71-0.78-derivation cohort) and 0.753 (95% confidence interval, 0.65-0.86-validation cohort). A cutoff of 4 or greater identified 60% of 30-day ED revisits in the derivation cohort and 80% of revisits in the validation cohort. CONCLUSIONS A risk score can identify ED visits for SCD pain with high risk of 30-day revisit.
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MESH Headings
- Adolescent
- Adult
- Age Distribution
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/economics
- Anemia, Sickle Cell/therapy
- Emergency Service, Hospital/economics
- Emergency Service, Hospital/standards
- Emergency Service, Hospital/statistics & numerical data
- Female
- Hospitals, Community
- Hospitals, Urban
- Humans
- Insurance Coverage
- Insurance, Health/classification
- Insurance, Health/statistics & numerical data
- Male
- Medical Records/statistics & numerical data
- Multicenter Studies as Topic
- New Jersey
- New York City
- Pain/drug therapy
- Pain/etiology
- Pain Measurement
- Patient Discharge/standards
- Patient Discharge/statistics & numerical data
- Patient Readmission/standards
- Patient Readmission/statistics & numerical data
- Propensity Score
- Retrospective Studies
- Risk Assessment/methods
- Socioeconomic Factors
- Young Adult
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Affiliation(s)
- Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai New York, NY.
| | - Jena Simon
- Department of Nursing, Icahn School of Medicine at Mount Sinai New York, NY.
| | - Nilesh Patel
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Jordan M Jeong
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Justin J McNamee
- Department of Emergency Medicine, St Joseph's Regional Medical Center, Paterson, NJ.
| | - Gary Yu
- NYU College of Nursing, New York, NY.
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10
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Mann-Jiles V, Thompson K, Lester J. Sleep impairment and insomnia in sickle cell disease: a retrospective chart review of clinical and psychological indicators. J Am Assoc Nurse Pract 2015; 27:441-9. [PMID: 25703174 DOI: 10.1002/2327-6924.12212] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/03/2014] [Indexed: 11/05/2022]
Abstract
PURPOSE To examine clinical and psychological indicators associated with sleeplessness and insomnia in adult patients with sickle cell. DATA SOURCES PubMed, Scopus, Cochrane Library. Data were collected from adult sickle cell participants (N = 72) in outpatient clinics at a Midwest National Cancer Institute designated comprehensive cancer center. A retrospective chart review observed for clinical and psychological indicators associated with sleeplessness and insomnia. CONCLUSIONS Findings included that adults with sickle cell experienced insomnia (47%) and sleep impairment (15%). Significant associations existed between pain and sleep impairment (p = .00), insomnia and pain (p = .00), morning hours of sleep (p = .00), and evening hours (p = .00). Pain may contribute to insomnia or interrupt sleep; daytime sleeping was not conducive to nighttime sleep. Anxiolytics, antidepressants, and long-acting opioids were not associated with insomnia (p = .00, p = .43, and p = .10), respectively; reduction in anxiety may reduce insomnia. Long-acting opioids may provide for improved pain control sleep. IMPLICATIONS FOR PRACTICE Healthcare providers play a pivotal role in the assessment of sleep impairment or disorders. Effective management is necessary for improved quality of life. Further investigation is warranted to understand the meaning of sleep impairment in adult patients with sickle cell with prospective controlled studies to examine the efficacy of interventions.
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Affiliation(s)
- Valerie Mann-Jiles
- Sickle Cell Clinics, James Cancer Hospital & Solove Research Institute, The Ohio State University, Columbus, Ohio.,College of Nursing, Capital University, Columbus, Ohio
| | - Kathrynn Thompson
- James Cancer Hospital & Solove Research Institute, Columbus, Ohio.,College of Nursing, The Ohio State University, Columbus, Ohio
| | - Joanne Lester
- Department of Psychology, Comprehensive Cancer Clinic, The Ohio State University, Columbus, Ohio.,Division of Surgical Oncology, The Ohio State University, Columbus, Ohio
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11
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Adewoyin AS. Management of sickle cell disease: a review for physician education in Nigeria (sub-saharan Africa). Anemia 2015; 2015:791498. [PMID: 25667774 PMCID: PMC4312619 DOI: 10.1155/2015/791498] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 11/18/2014] [Accepted: 12/17/2014] [Indexed: 11/27/2022] Open
Abstract
Sickle cell disease (SCD) predominates in sub-Saharan Africa, East Mediterranean areas, Middle East, and India. Nigeria, being the most populous black nation in the world, bears its greatest burden in sub-Saharan Africa. The last few decades have witnessed remarkable scientific progress in the understanding of the complex pathophysiology of the disease. Improved clinical insights have heralded development and establishment of disease modifying interventions such as chronic blood transfusions, hydroxyurea therapy, and haemopoietic stem cell transplantation. Coupled with parallel improvements in general supportive, symptomatic, and preventive measures, current evidence reveals remarkable appreciation in quality of life among affected individuals in developed nations. Currently, in Nigeria and other West African states, treatment and control of SCD are largely suboptimal. Improved knowledge regarding SCD phenotypes and its comprehensive care among Nigerian physicians will enhance quality of care for affected persons. This paper therefore provides a review on the aetiopathogenesis, clinical manifestations, and management of SCD in Nigeria, with a focus on its local patterns and peculiarities. Established treatment guidelines as appropriate in the Nigerian setting are proffered, as well as recommendations for improving care of affected persons.
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Affiliation(s)
- Ademola Samson Adewoyin
- Department of Haematology and Blood Transfusion, University of Benin Teaching Hospital, PMB 1111, Benin City, Edo State, Nigeria
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12
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O'Connor S, Hanes D, Lindsey A, Weiss M, Petty L, Overcash J. Attitudes among healthcare providers and patients diagnosed with sickle cell disease. Clin J Oncol Nurs 2014; 18:675-80. [PMID: 25427701 DOI: 10.1188/14.cjon.675-680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sickle cell disease (SCD) is a chronic condition that affects thousands of people worldwide. The purpose of this study is to illustrate some of the challenges and perceptions of people diagnosed with SCD. The aims were to describe stressors, problematic symptoms, sources of support, and interactions with healthcare providers. This descriptive study, using mostly open-ended questions and conceptual analysis, included a sample of patients with SCD who were older than 18 years in ambulatory (57%) and inpatient (43%) clinics. Participants completed a 20-minute interview. Pain or SCD crisis were the chief reasons for hospitalization, and a wellness checkup was the chief reason people returned to an ambulatory clinic. Most (74%) were able to perform chores. Family was reported to cause the most stress in the home and also provide the most help. Pain is a pervasive aspect of life, limiting activities of daily living. Negative interactions with healthcare providers are common; therefore, advocacy is necessary for patients with SCD.
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Affiliation(s)
| | - Deborah Hanes
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Amy Lindsey
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Mary Weiss
- Ohio State University Comprehensive Cancer Center, Columbus
| | - Lorie Petty
- Ohio State University Comprehensive Cancer Center, Columbus
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13
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Williams-Gray B, Senreich E. Challenges and resilience in the lives of adults with sickle cell disease. SOCIAL WORK IN PUBLIC HEALTH 2014; 30:88-105. [PMID: 25376027 DOI: 10.1080/19371918.2014.938396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This qualitative study focused on the experiences of adults living with sickle cell disease (SCD) in the New York City area. Twenty-three individuals participated in one of three focus groups. The purpose of this study was to learn if appropriate health care for individuals with sickle cell disease, based on years of research, has been implemented. The findings indicate that best practices in the treatment of SCD are often not followed by medical personnel. Critical race theory provides a framework to understand the 10 emergent themes. The participants' responses illustrate resilience in facing adversity. Implications for social work practice are presented.
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14
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Kato-Lin YC, Krishnamurti L, Padman R, Seltman HJ. Does e-pain plan improve management of sickle cell disease associated vaso-occlusive pain crisis? a mixed methods evaluation. Int J Med Inform 2014; 83:814-24. [PMID: 25179666 DOI: 10.1016/j.ijmedinf.2014.08.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 08/01/2014] [Accepted: 08/11/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE There is limited application and evaluation of health information systems in the management of vaso-occlusive pain crises in sickle cell disease (SCD) patients. This study evaluates the impact of digitization of paper-based individualized pain plans on process efficiency and care quality by examining both objective patient data and subjective clinician insights. METHODS Retrospective, before and after, mixed methods evaluation of digitization of paper documents in Children's Hospital of Pittsburgh of UPMC. Subjective perceptions are analyzed using surveys completed by 115 clinicians in emergency department (ED) and inpatient units (IP). Objective effects are evaluated using mixed models with data on 1089 ED visits collected via electronic chart review 28 months before and 22 months after the digitization. RESULTS Surveys indicate that all clinicians perceived the digitization to improve the efficiency and quality of pain management. Physicians overwhelmingly preferred using the digitized plans, but only 44% of the nurses had the same response. Analysis of patient records indicates that adjusted time from analgesic order to administration was significantly reduced from 35.50 to 26.77 min (p<.05). However, time to first dose and some of the objective quality measures (time from administration to relief, relief rate, admission rate, and ED re-visit rate) were not significantly affected. DISCUSSION The relatively simple intervention, high baseline performance, and limited accommodation of nurses' perspectives may account for the marginal improvements in process efficiency and quality outcomes. Additional efforts, particularly improved communication between physicians and nurses, are needed to further enhance quality of pain management. CONCLUSION This study highlights the important role of health information technology (HIT) on vaso-occlusive pain management for pediatric patients with sickle cell disease and the critical challenges in accommodating human factor considerations in implementing and evaluating HIT effects.
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Affiliation(s)
- Yi-Chin Kato-Lin
- The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA.
| | - Lakshmanan Krishnamurti
- Aflac Center for Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rema Padman
- The H. John Heinz III College, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Howard J Seltman
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA, USA
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15
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Jenerette C, Leak A. The role of oncology nurses in the care of adults with sickle cell disease. Clin J Oncol Nurs 2013. [PMID: 23178356 DOI: 10.1188/12.cjon.633-635] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oncology nurses are experts in pain management, and pain is the hallmark of sickle cell disease (SCD). Because individuals with cancer and individuals with SCD often receive care from hematologists or oncologists and are admitted to the same nursing units, oncology nurses need to have an understanding of SCD and the challenges that these individuals face.
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16
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Sandoval M, Coleman P, Govani R, Siddiqui S, Todd KH. Pilot Study of Human Recombinant Hyaluronidase–Enhanced Subcutaneous Hydration and Opioid Administration for Sickle Cell Disease Acute Pain Episodes. J Pain Palliat Care Pharmacother 2013; 27:10-8. [DOI: 10.3109/15360288.2012.758683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Jenerette CM, Brewer CA, Ataga KI. Care seeking for pain in young adults with sickle cell disease. Pain Manag Nurs 2013; 15:324-30. [PMID: 23343879 DOI: 10.1016/j.pmn.2012.10.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/25/2022]
Abstract
In individuals with sickle cell disease (SCD), recognizing the cues to an acute pain episode and responding appropriately are important. The purpose of this mixed-methods pilot study is to identify preliminary factors that influence care seeking for pain in young adults with SCD. Responses were received from 69 young adults with SCD, age 18-35 years. The majority of respondents (88%) wait until the pain intensity is an average of 8.7 (± 1.2) on a scale of 1 to 10 before seeking care. Prominent themes influencing care seeking for pain include: trying to treat pain at home, avoiding the emergency department because of past treatment experiences, the desire to avoid admission to the hospital, and the importance of time in the lives of the young adults with SCD. Young adults with SCD need additional support from family and healthcare providers in order to make timely, appropriate decisions regarding care seeking.
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Affiliation(s)
- Coretta M Jenerette
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Cheryl A Brewer
- Duke Cancer Care Research Program, Duke Cancer Institute, Durham, North Carolina
| | - Kenneth I Ataga
- Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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18
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Jenerette C, Brewer CA, Crandell J, Ataga KI. Preliminary validity and reliability of the Sickle Cell Disease Health-Related Stigma Scale. Issues Ment Health Nurs 2012; 33:363-9. [PMID: 22646200 DOI: 10.3109/01612840.2012.656823] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There have been no published studies that measure health-related stigma in individuals with sickle cell disease (SCD). This study provides preliminary validity and reliability of the Sickle Cell Disease Health-Related Stigma Scale (SCD-HRSS). Using a sample of 77 young adults with SCD, ages 18-35 years, the results support the reliability of the SCD-HRSS with an overall Cronbach's alpha reliability of 0.84 and construct validity with a positive correlation between SCD-HRSS and a measure of depressive symptoms. Participants reported the highest levels of perceived stigma from the general public, then doctors, and lastly family. Limitations and directions for future research are discussed.
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Affiliation(s)
- Coretta Jenerette
- School of Nursing, The University of North Carolina at Chapel Hill, NC, USA
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19
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Quinlan J, Carter K. Acute pain management in patients with persistent pain. Curr Opin Support Palliat Care 2012; 6:188-93. [DOI: 10.1097/spc.0b013e3283520fb6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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20
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Situation, Background, Assessment, and Recommendation (SBAR) May Benefit Individuals Who Frequent Emergency Departments: Adults With Sickle Cell Disease. J Emerg Nurs 2011; 37:559-61. [DOI: 10.1016/j.jen.2011.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/09/2011] [Accepted: 02/10/2011] [Indexed: 11/20/2022]
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21
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Feliu MH, Wellington C, Crawford RD, Wood M, Edwards L, Byrd G, Edwards CL. Opioid management and dependency among adult patients with sickle cell disease. Hemoglobin 2011; 35:485-94. [PMID: 21910605 DOI: 10.3109/03630269.2011.610914] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
While pain is one of the most debilitating symptoms of sickle cell disease, narcotics remain an effective although controversial widely practiced intervention. Vaso-occlusive crises are the most common cause for seeking pharmacological treatment. The influence of stigmatization and pseudo addiction in emergency departments and outpatient clinics was reviewed. We analyzed patterns of narcotic utilization in a sample of 63 adult patients with sickle cell disease to determine if their psychological functioning and reports of pain differed as a function of the primary narcotics they were taking for oral pain management. Fifty-one percent of patients reported treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine. Patients who were treated with Oxycodone reported greater sensory reactions to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged weekly pain intensity ratings than patients who did not use this medication. There were no differences in pain or affective response in patients treated with OxyContin, methadone or morphine. We suggest there are clear differences between the reports of pain in patients with sickle cell disease taking short-acting narcotics for pain management as compared to those who are not, a pattern that does not distinguish patients who are managed with long-acting preparations. We discuss the relevance of addressing narcotic management in the context of the perception of health care providers and patients with sickle cell disease.
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Affiliation(s)
- Miriam H Feliu
- Department of Psychiatry, Duke University, Durham, North Carolina 27705, USA.
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22
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dos Santos JL, Lanaro C, Lima LM, Gambero S, Franco-Penteado CF, Alexandre-Moreira MS, Wade M, Yerigenahally S, Kutlar A, Meiler SE, Costa FF, Chung M. Design, Synthesis, and Pharmacological Evaluation of Novel Hybrid Compounds To Treat Sickle Cell Disease Symptoms. J Med Chem 2011; 54:5811-9. [DOI: 10.1021/jm200531f] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jean Leandro dos Santos
- Laboratório de Pesquisa e Desenvolvimento de Fármacos (Lapdesf), Departamento de Fármacos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista (UNESP), Rodovia Araraquara Jaú Km. 01, 14801-902, Araraquara, SP, Brazil
| | - Carolina Lanaro
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Lídia Moreira Lima
- Laboratório de Avaliação e Síntese de Substâncias Bioativas (LASSBio, ), Faculdade de Farmácia, Universidade Federal do Rio de Janeiro, P.O. Box 68024, 21944-971, Rio de Janeiro, RJ, Brazil
| | - Sheley Gambero
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Carla Fernanda Franco-Penteado
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - Magna Suzana Alexandre-Moreira
- Laboratório de Farmacologia e Imunidade (LaFI), Instituto de Ciências Biológicas e da Saúde, Universidade Federal de Alagoas, Maceió, AL, Brazil
| | - Marlene Wade
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Shobha Yerigenahally
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Abdullah Kutlar
- Sickle Cell Center, Medical College of Georgia, Augusta, Georgia, United States
| | - Steffen E. Meiler
- Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Augusta, Georgia, United States
| | - Fernando Ferreira Costa
- The Haematology and Haemotherapy Centre, University of Campinas (UNICAMP), Hemocentro, Rua Carlos Chagas, 480, Cidade Universitária, Barão Geraldo, 13083-970, Campinas, SP, Brazil
| | - ManChin Chung
- Laboratório de Pesquisa e Desenvolvimento de Fármacos (Lapdesf), Departamento de Fármacos e Medicamentos, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista (UNESP), Rodovia Araraquara Jaú Km. 01, 14801-902, Araraquara, SP, Brazil
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