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Darby JE, Akpotu IC, Wi D, Ahmed S, Doorenbos AZ, Lofton S. A Scoping Review of Social Determinants of Health and Pain Outcomes in Sickle Cell Disease. Pain Manag Nurs 2024:S1524-9042(24)00258-3. [PMID: 39370347 DOI: 10.1016/j.pmn.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/16/2024] [Accepted: 09/08/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Sickle cell disease (SCD) is a hereditary blood disorder with chronic pain that affects over 100,000 people in the United States. Previous research suggests a complex interaction between SCD pain outcomes and social determinants of health (SDOH). OBJECTIVE To explore the impact of SDOH on pain outcomes in SCD. DESIGN We used a scoping review design to explore the broad topic of social factors that affect SCD pain. DATA SOURCES We searched the PubMed/MEDLINE, CINAHL, and Embase databases using combined search and Medical Subject Headings terms ("social determinants of health," "sickle cell," and "pain"). REVIEW METHODS We used a content analysis with a summative approach to identify and describe interactions between SDOH and SCD pain outcomes. FINDINGS Eight articles reporting studies with 7,992 total participants and a focus on SCD pain outcomes met the inclusion criteria. Three themes related to SDOH and pain were produced: education and employment, social and emotional functioning, and healthcare access. CONCLUSION The key findings highlight the complex interplay between socioeconomic, psychological, and biological factors in SCD pain experiences. This underscores the need for nursing care to consider SDOH in an integrated, holistic approach to SCD pain. IMPLICATIONS FOR NURSING To improve pain management among their SCD patients, nurses can assess pain holistically, develop customized individual pain management plans with educational and health literacy support options, and strengthen social support.
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Affiliation(s)
- Juanita E Darby
- College of Nursing, University of Illinois Chicago, Chicago, IL.
| | - Ivy C Akpotu
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Dahee Wi
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | - Sarah Ahmed
- College of Nursing, University of Illinois Chicago, Chicago, IL
| | | | - Saria Lofton
- College of Nursing, University of Illinois Chicago, Chicago, IL
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Fields LE, Leimbach E, Mishkin AD, Carroll CP, Prince EJ. Consultation Liaison Case Conference: Inpatient Psychiatric Consultation for Patients with Sickle Cell Disease. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00095-8. [PMID: 39370112 DOI: 10.1016/j.jaclp.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 09/10/2024] [Accepted: 09/29/2024] [Indexed: 10/08/2024]
Abstract
We present the fictional case of a 29-year-old man with sickle cell disease referred to psychiatry for evaluation of depression during an acute pain episode. Consultation-liaison psychiatrists with expertise in sickle cell disease provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the high prevalence of mood and cognitive disorders in this population, as well as pertinent issues related to chronic pain, opioids, and stigma.
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Affiliation(s)
- Lauren E Fields
- Massachusetts General Hospital, 15 Parkman Street, WACC 812, Boston, MA 02114, United States.
| | - Elizabeth Leimbach
- Columbia University Irving Medical Center, 622 W 168(th) Street, New York, NY 10032, United States
| | - Adrienne D Mishkin
- Columbia University Irving Medical Center, 622 W 168(th) Street, New York, NY 10032, United States
| | - C Patrick Carroll
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
| | - Elizabeth J Prince
- Johns Hopkins School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States
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Liu SA, Brown TR, King AA, Lin LA, Rehman SS, Grucza RA, Xu KY. Opioid-related emergency admissions in people with opioid dependence/use disorder with and without sickle cell disease: An analysis of multi-state insurance claims. Gen Hosp Psychiatry 2024; 91:83-88. [PMID: 39378616 DOI: 10.1016/j.genhosppsych.2024.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 08/02/2024] [Accepted: 09/22/2024] [Indexed: 10/10/2024]
Abstract
OBJECTIVE We estimated rates of opioid-related admissions in people with sickle cell disease (SCD) diagnosed with opioid-related disorders. METHOD We analyzed ten years (1/2006-12/2016) of multi-state claims data from 191,638 people receiving treatment for opioid-related disorders in the U.S. We used multivariable cox regression to estimate the association between admissions for opioid-related adverse events after initiating treatment and SCD status (SCD[n = 320] vs no SCD[n = 191,318]) among people with opioid-related disorders, controlling for sociodemographic variables and comorbidities. In secondary analyses, we excluded events occurring simultaneously as vaso-occlusive crises (VOCs) and computed rates of admissions for non-opioid substance-related events (i.e., alcohol, cannabis). RESULTS Whereas 287(90 %) of the SCD cohort had >1 all-cause admission, of which 199 were for VOCs, only 78(20 %) experienced an opioid-related adverse event. The SCD cohort experienced higher rates of opioid-related admissions than the non-SCD cohort (aHR = 1.82[95 % CI = 1.51-2.19), a finding that remained robust even after excluding events that occurred at the same time as a VOC. SCD diagnoses were not associated with admissions for non-opioid substance-related events. CONCLUSIONS Even though clinicians may perceive people with SCD as being at elevated risk for substance use disorders, opioid-related admissions made up only a small fraction of all-cause admissions among people with SCD diagnosed with opioid-related disorders, in contrast to VOCs that comprised the majority of admissions. Opioid-related admissions, while modestly higher among those with SCD than among peers without SCD, were relatively uncommon.
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Affiliation(s)
- Shiyuan A Liu
- Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America
| | - Tashalee R Brown
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America; Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, Los Angeles, CA 90024, United States of America
| | - Allison A King
- Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America; Division of Hematology and Oncology, Department of Pediatrics, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America
| | - Lewei Allison Lin
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Rd, Ann Arbor, MI 48109, United States of America; Center for Clinical Management Research (CCMR), Veteran Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States of America
| | - Sana S Rehman
- Division of Hematology and Oncology, Department of Medicine, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America
| | - Richard A Grucza
- Departments of Family and Community Medicine and Health and Outcomes Research, St. Louis University, 1008 S. Spring Avenue, St. Louis, MO 63110, United States of America
| | - Kevin Y Xu
- Health and Behavior Research Center, Department of Psychiatry, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO 63110, United States of America.
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Matthie N, Jenerette C. Knowledge and Experience of In-home Virtual Reality for Chronic Pain in Sickle Cell Disease. THE JOURNAL OF PAIN 2024:104668. [PMID: 39243922 DOI: 10.1016/j.jpain.2024.104668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Abstract
Many adults with sickle cell disease experience chronic, non-vaso-occlusive pain that can benefit from non-pharmacological interventions available for use in the home setting. Virtual reality has been shown to be effective in decreasing pain in chronic pain conditions and may be useful for home-based self-management of chronic pain in sickle cell. However, the literature lacks studies examining this potential. Additionally, the knowledge and experiences of adults with sickle cell who have tried virtual reality for home-based chronic pain management have not yet been reported. This qualitative, descriptive pilot study explored the knowledge and perceptions of virtual reality among adults with sickle cell and their experience with using in-home virtual reality for chronic pain. Nine participants completed demographic questionnaires and an individual interview that was recorded, transcribed verbatim, and analyzed using thematic analysis. Participants were 21 to 38 years of age, and most were female (88.9%) with a medium or high sickle cell disease severity (88.9%) and a chronic pain grade classification of Grade III (high disability-moderately limiting) or Grade IV (high disability-severely limiting) (55.5%). Interview themes, which aligned with the Technology Acceptance Model, were: (1) pain beliefs and self-management; (2) virtual reality as another world; and (3) experience of using in-home virtual reality. Based on preliminary data, virtual reality shows promise as a strategy for non-pharmacological management of chronic pain in adults with sickle cell. However, further investigations are warranted to mitigate the challenges and limitations associated with using virtual reality in this capacity. PERSPECTIVE: Few evidence-based, non-pharmacological interventions exist for chronic pain in adults with sickle cell disease (SCD). This first qualitative, pilot study of in-home VR for chronic pain in adults with SCD suggests that VR interventions need further exploration as a non-pharmacological strategy for mitigating their pain in the home setting.
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Affiliation(s)
- Nadine Matthie
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Coretta Jenerette
- Thelma Shobe Endowed Chair and Professor; University of California San Francisco, School of Nursing, Community Health Systems, Box 0608, 490 Illinois Street, Floor 9, San Francisco, CA 94143, USA.
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Kaponda A, Muya K, Panda J, Koto KK, Bonnechère B. Unraveling the Complexity of Vaso-Occlusive Crises in Sickle Cell Disease: Insights from a Resource-Limited Setting. J Clin Med 2024; 13:2528. [PMID: 38731057 PMCID: PMC11084179 DOI: 10.3390/jcm13092528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: This study investigated vaso-occlusive crises (VOCs) in sickle cell disease in Lubumbashi, Democratic Republic of Congo, aiming to understand the disease complexities amidst limited resources. With sickle cell hemoglobinopathies on the rise in sub-Saharan Africa, this nine-year study explored factors associated with VOCs and hematological components. Methods: This study comprised 838 patients, analyzing VOCs and hematological changes over time. Demographic characteristics and blood composition changes were carefully categorized. A total of 2910 crises were observed and managed, with analyses conducted on severity, localization, and age groups using statistical methods. Results: The majority of crises were mild or moderate, primarily affecting osteoarticular regions. Statistical analysis revealed significant disparities in crisis intensity based on location and age. The association between blood samples and the number of comorbidities was investigated. Significant positive associations were found for all parameters, except monocytes, indicating a potential link between blood variables and complication burden. Survival analysis using Cox regression was performed to predict the probability of experiencing a second crisis. No significant effects of medication or localization were observed. However, intensity (p < 0.001), age (p < 0.001), and gender (p < 0.001) showed significant effects. Adjusted Hazard Ratios indicated increased risk with age and male gender and reduced risk with mild or severe crisis intensity compared to light. Conclusions: This research sheds light on the complexities of VOCs in resource-limited settings where sickle cell disease is prevalent. The intricate interplay between clinical, laboratory, and treatment factors is highlighted, offering insights for improved patient care. It aims to raise awareness of patient challenges and provide valuable information for targeted interventions to alleviate their burden.
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Affiliation(s)
- Ali Kaponda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kalunga Muya
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo;
| | - Jules Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kodondi Kule Koto
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa 2212, Democratic Republic of the Congo;
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, 3590 Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, 3590 Hasselt, Belgium
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium
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Prince EJ, Carroll CP, Pecker LH. Psychiatry referral and appointment attendance in a clinic for young adults with sickle cell disease. Pediatr Blood Cancer 2024; 71:e30860. [PMID: 38197728 PMCID: PMC10956472 DOI: 10.1002/pbc.30860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/11/2024]
Abstract
Mental illness is a common sickle cell disease (SCD) comorbidity. This observational study evaluated psychiatry appointment attendance among 137 young adults with SCD. In their first year of adult SCD care, 43% of subjects were referred to psychiatry. Referral was associated with chronic transfusion therapy. Twenty-four percent of subjects attended a psychiatry appointment; attendance was associated with the appointment being scheduled within 6 weeks of referral and no subject characteristics. Ninety-one percent of subjects attending psychiatry appointments had a psychiatric disorder. Among young adults with SCD, psychiatric morbidity is high. Psychiatric services are, therefore, essential for this patient population.
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Affiliation(s)
- Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lydia H Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Nwora C, Prince EJ, Pugh L, Weaver MS, Pecker LH. How young adults with sickle cell disease define "being a good patient" in the adult healthcare system. Pediatr Blood Cancer 2024; 71:e30786. [PMID: 38053232 PMCID: PMC10841975 DOI: 10.1002/pbc.30786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/21/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Young adulthood brings new challenges for managing sickle cell disease. There are fewer adult specialists, sickle cell disease morbidities accumulate, and mortality increases. Developmental changes in roles and responsibilities also affect management. This study explores how young adults with sickle cell disease experience their role as a patient. METHODS In this mixed-methods study at a sickle cell center, young adult participants completed the Sickle Cell Self Efficacy Survey, the Measures of Sickle Cell Stigma, and the Adult Sickle Cell Quality of Life Measurement Short-Forms. Semi-structured interviews on the patient role were conducted, transcribed, and then analyzed using thematic analysis. RESULTS Twenty-four participants aged 19-25 years defined expectations of being a "good patient." Five definitional themes emerged: health maintenance, emotion regulation, self-advocacy, honest communication, and empathy for clinicians. Participants identified support from families and clinicians are important facilitators of role fulfillment. DISCUSSION How young adult patients with sickle cell disease define being a "good patient" has implications for the transition of care for both pediatric and adult medicine practices. This understanding can inform healthcare system designs and programs aimed at supporting patients and families.
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Affiliation(s)
- Christle Nwora
- Department of Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Elizabeth J. Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Laura Pugh
- Internal Medicine Resident, University of California San Francisco, San Francisco, CA
| | - Meaghann S. Weaver
- National Center for Ethics in Healthcare, Veteran Affairs, Washington DC
| | - Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD
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