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Harris EM, Oni MO, Donado C, Heeney MM, Solodiuk J, Greco C, Archer NM. The Risk of Kidney Injury in Patients With Sickle Cell Disease Treated With Ketorolac for Acute Pain. J Pediatr Hematol Oncol 2024; 46:e290-e295. [PMID: 38691085 DOI: 10.1097/mph.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/20/2024] [Indexed: 05/03/2024]
Abstract
Ketorolac, a nonsteroidal anti-inflammatory drug, is used in combination with opioids to manage vaso-occlusive episodes (VOEs). The relationship between ketorolac use and kidney injury in pediatric patients with sickle cell disease (SCD) remains incompletely understood. We hypothesize that ketorolac is associated with acute kidney injury (AKI) in patients with SCD presenting with pain. All nonsurgical hospitalizations for VOEs treated with ketorolac between January 2014 and December 2022 were included. We used optimal matching methodology to identify control admissions (2:1 ratio) and used nonparametric tests to compare ketorolac administration between cases and controls. A total of 1319 encounters/253 patients were included in this study. AKI was noted in 1.1% of encounters and 5.5% of patients. Cases had significantly higher initial BUN than controls (9.0 vs. 6.0 mg/dL, P =0.012). In cases versus controls, there was significantly lower serum sodium (136.0 vs. 138.0 mmol/L, P =0.021). There was no association between ketorolac dose and development of AKI among children with SCD. Higher BUN and lower sodium in cases suggest that patients with AKI were more volume depleted on admission than controls. This highlights the need for strict assessment of fluid status upon admission for VOE.
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Affiliation(s)
- Emily M Harris
- Department of Pediatrics, Boston Children's Hospital
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
| | - Morohuntodun O Oni
- Department of Pediatrics, Boston Children's Hospital
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
| | - Carolina Donado
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Matthew M Heeney
- Department of Pediatrics, Boston Children's Hospital
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
| | - Jean Solodiuk
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Christine Greco
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital
| | - Natasha M Archer
- Department of Pediatrics, Boston Children's Hospital
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center
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2
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Krishnamurti L, Liang J, He Z, Deng Y, Nallagatla VR, Hamidi R, Flagg A, Shah N. Incidence and risk factors of pain crisis after hematopoietic cell transplantation for sickle cell disease. Blood Adv 2024; 8:1908-1919. [PMID: 38324722 PMCID: PMC11021890 DOI: 10.1182/bloodadvances.2023010749] [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: 05/15/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024] Open
Abstract
ABSTRACT Vaso-occlusive episodes (VOC) or pain crises are the most common indications for hematopoietic cell transplantation (HCT) for sickle cell disease (SCD). Elimination of pain crisis after HCT is an important patient-centered outcome and may improve understanding of the natural history of pain syndromes in SCD. We examined deidentified records of 763 patients followed-up for a median of 36.7 months (range, 0.3-168.6 months), with 69.6% patient's age <18 years at HCT, 83.3% patient's Karnofsky-Lansky performance score (KPS) ≥90, overall survival 92.9%, event-free survival 72.4%, graft failure (GF) 22.4%, AGVHD 21.4%, CGVHD 27%, and pain crisis 8.65%. On unadjusted logistic regression, increased risk of pain crisis after HCT was observed in patient's aged >10 years at HCT (range, 11-17 years; OR, 9.43; 95% CI, 3.20-27.79; P < .0001), in age ≥18 years (OR, 16.62; 95% CI, 5.85-47.16; P < .0001), in those with history of pain crisis 2 years before HCT (OR, 13.16; 95% CI, 4.08-42.42; P < .0001), alternate donors (haploidentical [OR, 4.80; 95% CI, 2.48-9.31; P < .0001], unrelated matched [OR, 2.71; 95% CI, 1.23-5.97; P = .0132], and mismatched unrelated [OR, 3.19; 95% CI, 1.44-7.05; P = .0041], and those with GF (n = 41 [5.37%]; OR, 7.15; 95% CI, 4.20-12.18; P < .0001). Pain crisis was less frequent with KPS of ≥90 (OR, 0.31; 95% CI, 0.18-0.55; P < .0001). Multivariable logistic regression models confirmed age at HCT, KPS, graft type, donor type, history of VOC 2 years before HCT, and GF as independent predictors of pain crisis after HCT and generated predictive models and nomograms for pain crisis after HCT for SCD, which can support shared decision making.
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Affiliation(s)
- Lakshmanan Krishnamurti
- Section of Pediatric Hematology-Oncology and Stem Cell Transplantation, Yale School of Medicine, New Haven, CT
| | - Jingchen Liang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Zili He
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT
| | - Vineetha R. Nallagatla
- Section of Pediatric Hematology-Oncology and Stem Cell Transplantation, Yale School of Medicine, New Haven, CT
| | | | - Aron Flagg
- Section of Pediatric Hematology-Oncology and Stem Cell Transplantation, Yale School of Medicine, New Haven, CT
| | - Niketa Shah
- Section of Pediatric Hematology-Oncology and Stem Cell Transplantation, Yale School of Medicine, New Haven, CT
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Kenney MO, Wilson S, Shah N, Bortsov A, Smith WR, Little J, Lanzkron S, Kanter J, Padrino S, Owusu-Ansah A, Cohen A, Desai P, Manwani D, Rehman SSU, Hagar W, Keefe F. Biopsychosocial Factors Associated With Pain and Pain-Related Outcomes in Adults and Children With Sickle Cell Disease: A Multivariable Analysis of the GRNDaD Multicenter Registry. THE JOURNAL OF PAIN 2024; 25:153-164. [PMID: 37544393 PMCID: PMC11261903 DOI: 10.1016/j.jpain.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
Pain is the primary symptomatic manifestation of sickle cell disease (SCD), an inherited hemoglobinopathy. The characteristics that influence pain experiences and outcomes in SCD are not fully understood. The primary objective of this study was to use multivariable modeling to examine associations of biopsychosocial variables with a disease-specific measure of pain interference known as pain impact. We conducted a secondary analysis of data from the Global Research Network for Data and Discovery national SCD registry. A total of 657 children and adults with SCD were included in the analysis. This sample was 60% female with a median age of 34 (interquartile range 26-42 years) and a chronic pain prevalence of 64%. The model accounted for 58% of the variance in pain impact. Low social (P < .001) and emotional (P < .001) functioning, increasing age (P = .004), low income (P < .001), and high acute painful episodes (P = .007) were most strongly associated with high pain impact in our multivariable model. Additionally, multivariable modeling of pain severity and physical function in 2 comparable samples of registry participants revealed that increasing age and low social functioning were also strongly associated with higher pain severity and low physical functioning. Overall, the results suggest that social and emotional functioning are more strongly associated with pain impact in individuals with SCD than previously studied biological modifiers such as SCD genotype, hemoglobin, and percentage fetal hemoglobin. Future research using longitudinally collected data is needed to confirm these findings. PERSPECTIVE: This study reveals that psychosocial (ie, social and emotional functioning) and demographic (ie, age) variables may play an important role in predicting pain and pain-related outcomes in SCD. Our findings can inform future multicenter prospective longitudinal studies aimed at identifying modifiable psychosocial predictors of adverse pain outcomes in SCD.
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Affiliation(s)
- Martha O. Kenney
- Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University, Durham, North Carolina
| | - Samuel Wilson
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
- UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Nirmish Shah
- Departments of Pediatrics & Hematology, Duke University, Durham, North Carolina
| | - Andrey Bortsov
- Center for Translational Pain Medicine, Duke University, Durham, North Carolina
| | - Wally R. Smith
- Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Jane Little
- Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
- UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sophie Lanzkron
- Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama, Birmingham, Alabama
| | - Susan Padrino
- School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Pediatric Hematology Oncology, University Hospitals Rainbow Babies & Children’s Hospital, Cleveland, Ohio
| | - Alice Cohen
- Division of Hematology and Oncology, Newark Beth Israel Medical Center, Newark, New Jersey
| | - Payal Desai
- Levin Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine and the Children’s Hospital at Montefiore (CHAM), Bronx, New York
| | - Sana Saif Ur Rehman
- Department of Medicine, Division of Hematology, Washington University School of Medicine, St. Louis, Missouri
| | - Ward Hagar
- Department of Pediatrics, UCSF Benioff Children’s Hospital, Oakland, California
| | - Francis Keefe
- Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina
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Connolly ME, Forman S, Sharkey CM, Merwin S, Darbari DS, Hardy SJ. Feasibility and preliminary efficacy of the Balance Program to reduce pain-related disability in pediatric sickle cell disease. Pediatr Blood Cancer 2023; 70:e30667. [PMID: 37726889 DOI: 10.1002/pbc.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking. METHODS Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills. RESULTS All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05). CONCLUSIONS The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Sydney Forman
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Christina M Sharkey
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Stephanie Merwin
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
| | - Deepika S Darbari
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
- Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA
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Sidhom D, Aboul-Hassan D, Clauw DJ, Cofield C, Bergmans R. Chronic pain management in sickle cell disease: A systematic scoping review of controlled trials. Crit Rev Oncol Hematol 2023; 190:104087. [PMID: 37541536 DOI: 10.1016/j.critrevonc.2023.104087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/20/2023] [Accepted: 07/30/2023] [Indexed: 08/06/2023] Open
Abstract
Existing treatment for chronic pain in sickle cell disease (SCD) is opioid-dependent, which is ineffective and carries risks. We conducted a scoping literature review to assess the size and scope of available literature about controlled trials of therapies for SCD chronic pain and identify research gaps. The search strategy in PubMed and EMBASE utilized keywords for chronic pain and sickle cell and identified seven original articles that met inclusion criteria. Six of the studies recruited from clinics while one recruited from community sources. Cannabis and behavioral modification were associated with improvements in pain scores. However, existing evidence does not represent best practices for assessing chronic pain, and this along with small sample sizes prevents translation to clinical care. The limited evidence concerning treatment for SCD chronic pain highlights the need for larger trials of opioid alternatives and the utilization of chronic pain measures that capture nociplastic pain in SCD.
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Affiliation(s)
- David Sidhom
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
| | - Cherie Cofield
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
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6
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Harris EM, Vilk E, Donado C, Williams A, Heeney MM, Solodiuk J, Greco C, Archer NM. Ketamine use for management of vaso-occlusive pain in pediatric sickle cell disease. Pediatr Blood Cancer 2023; 70:e30254. [PMID: 36861789 DOI: 10.1002/pbc.30254] [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: 11/23/2022] [Revised: 01/08/2023] [Accepted: 01/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Typical sickle cell disease (SCD) vaso-occlusive pain episode (VOE) management includes opioids, which are often inadequate and can be associated with significant side effects. Ketamine, a dissociative anesthetic, is a potentially effective adjunct to VOE management. OBJECTIVES This study aimed to characterize ketamine use for VOE management in pediatric SCD. METHOD This retrospective case series summarizes a single-center experience regarding the use of ketamine for inpatient management of pediatric VOE in 156 admissions from 2014 to 2020. RESULTS Continuous low-dose ketamine infusion was most commonly prescribed to adolescents and young adults as an adjunct to opioids (median starting dose 2.0 μg/kg/min; median maximum dose 3.0 μg/kg/min). Ketamine was started a median of 13.7 hours after admission. Median ketamine infusion duration was 3 days. In most encounters, ketamine infusion was discontinued prior to opioid patient-controlled analgesia (PCA) discontinuation. The majority of encounters (79.3%) had a reduction in either PCA dose, continuous opioid infusion, or both while receiving ketamine. Low-dose ketamine infusion was associated with side effects noted in 21.8% (n = 34) of encounters. The most common side effects included dizziness (5.6%), hallucinations (5.1%), dissociation (2.6%), and sedation (1.9%). There were no reports of ketamine withdrawal. Most patients who received ketamine went on to receive it again during a subsequent admission. CONCLUSION Further study is needed to determine the optimal timing of ketamine initiation and dosing. The variability of ketamine administration highlights the need for standardized protocols for ketamine use in VOE management.
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Affiliation(s)
- Emily M Harris
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emily Vilk
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Carolina Donado
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexis Williams
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew M Heeney
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jean Solodiuk
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Christine Greco
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha M Archer
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
- Division of Hematology, Boston Children's Hospital, Boston, Massachusetts, USA
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7
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Donado C, Harris EM, Heeney MM, Solodiuk JC, Greco CD, Archer NM. Patient Controlled Analgesia for Vaso-Occlusive Episodes in Children: A Retrospective Study. J Pain Symptom Manage 2023; 65:e409-e415. [PMID: 36641004 DOI: 10.1016/j.jpainsymman.2022.12.147] [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: 07/11/2022] [Revised: 11/29/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe Patient-Controlled Analgesia (PCA) administration in pediatric patients admitted with sickle cell vaso-occlusive episode (VOE). METHODS This single-center retrospective study included all inpatient hematology admissions for VOE between 2014 and 2020. PCA-ratio was calculated as the ratio of bolus over continuous IV opioids dose, and time to PCA adjustment as time between first PCA order and a subsequent order that increased dosing or changed opioid medication. RESULTS A total of 866 encounters (172 unique patients) with PCA for VOE were included. The mean age was 15.4 years old (SD = 5.0). On average, after admission (hospital arrival), the first opioid dose was given at 1 hour, PCA started at 3.5 hours, and mean length of stay was 4.3 days (SD = 2.5). The mean initial PCA-ratio was 1.7 (SD = 0.6). There were no significant associations between age, gender, initial pain score, or admission hemoglobin and PCA-ratio (linear regression model P = 0.443). In 24.7% of encounters, the PCA was adjusted within 6 hours. After adjusting by age and gender, lower admission pain scores (OR = 1.15, P = 0.004), lower PCA-ratio (OR = 2.1, P = 0.003), longer time to PCA start (OR = 1.2, P = 0.001), and no adjuvant ketamine (OR = 2.4, P < 0.001) were associated with PCA unadjusted within 6 hours. CONCLUSION At our institution, patients with VOE received opioids and PCA within the first hours of admission. PCAs were started at a ratio of 1.5-1.8, considered normal continuous. While no specific PCA-ratio was clearly superior for pain control, lower ratios (high continuous infusion) were associated with not requiring PCA adjustments at 6 hours. Prospective studies are needed.
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Affiliation(s)
- Carolina Donado
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA; Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
| | - Emily M Harris
- Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA
| | - Matthew M Heeney
- Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA; Division of Hematology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (M.M.H., N.M.A.), Boston, Massachusetts, USA
| | - Jean C Solodiuk
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA; Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
| | - Christine D Greco
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA; Department of Anaesthesia, Harvard Medical School (C.D., J.C.S., C.D.G.), Boston, Massachusetts, USA
| | - Natasha M Archer
- Department of Pediatrics, Boston Children's Hospital (E.M.H., M.M.H., N.M.A.), Boston, Massachusetts, USA; Division of Hematology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center (M.M.H., N.M.A.), Boston, Massachusetts, USA.
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Shastri AA, Lombardo J, Okere SC, Higgins S, Smith BC, DeAngelis T, Palagani A, Hines K, Monti DA, Volpe S, Mitchell EP, Simone NL. Personalized Nutrition as a Key Contributor to Improving Radiation Response in Breast Cancer. Int J Mol Sci 2021; 23:175. [PMID: 35008602 PMCID: PMC8745527 DOI: 10.3390/ijms23010175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023] Open
Abstract
Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for our patients. To date, radiation therapy regimens are prescribed based on tumor type and stage. Patient populations who are noted to have a poor response to radiation such as those of African American descent, those who have obesity or metabolic syndrome, or senior adult oncology patients, should be considered for concurrent therapies with radiation that will improve response. Here, we explore these populations of breast cancer patients, who frequently display radiation resistance and increased mortality rates, and identify the molecular underpinnings that are, in part, responsible for the radiation response and that result in an immune-suppressive tumor microenvironment. The resulting immune phenotype is discussed to understand how antitumor immunity could be improved. Correcting nutrient deficiencies observed in these populations should be considered as a means to improve the therapeutic index of radiation therapy.
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Affiliation(s)
- Anuradha A. Shastri
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Joseph Lombardo
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Samantha C. Okere
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Stephanie Higgins
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Brittany C. Smith
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Tiziana DeAngelis
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Ajay Palagani
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Kamryn Hines
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
| | - Daniel A. Monti
- Department of Integrative Medicine and Nutritional Sciences, Marcus Institute of Integrative Health, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Stella Volpe
- Department of Human Nutrition, Foods and Exercise, College of Agriculture and Life Sciences, Virginia Tech, Blacksburg, VA 24061, USA;
| | - Edith P. Mitchell
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Nicole L. Simone
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.A.S.); (J.L.); (S.C.O.); (S.H.); (B.C.S.); (T.D.); (A.P.); (K.H.)
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9
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Nogrady B. Why severe sickle-cell pain has been neglected. Nature 2021. [PMID: 34433957 DOI: 10.1038/d41586-021-02142-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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10
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Harris EM, Vilk E, Heeney MM, Solodiuk J, Greco C, Archer NM. A systematic review of ketamine for the management of vaso-occlusive pain in sickle cell disease. Pediatr Blood Cancer 2021; 68:e28989. [PMID: 33788404 DOI: 10.1002/pbc.28989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 01/13/2023]
Abstract
Vaso-occlusive episodes (VOEs) are a common complication of sickle cell disease (SCD) and a significant cause of morbidity. Managing VOE pain can be difficult and complex. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been used to manage VOE pain. This systematic literature review synthesizes research published from 2010 to 2020 on the use of ketamine infusion to decrease VOE pain. The review demonstrates that ketamine, a safe and effective treatment for VOE pain, could be considered more widely. However, the significant variability among published clinical studies with regard to dosing, timing of initiation, duration of infusion, and timing of discontinuation highlights the need for standardized ketamine infusion protocols for the management of VOE pain. We conclude with a brief discussion of key components of a potential standardized protocol supported by the literature reviewed as well as areas for future investigation.
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Affiliation(s)
- Emily M Harris
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Emily Vilk
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Matthew M Heeney
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - Jean Solodiuk
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Christine Greco
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Natasha M Archer
- Pediatric Hematology/Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
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11
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American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv 2021; 4:2656-2701. [PMID: 32559294 DOI: 10.1182/bloodadvances.2020001851] [Citation(s) in RCA: 173] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The management of acute and chronic pain for individuals living with sickle cell disease (SCD) is a clinical challenge. This reflects the paucity of clinical SCD pain research and limited understanding of the complex biological differences between acute and chronic pain. These issues collectively create barriers to effective, targeted interventions. Optimal pain management requires interdisciplinary care. OBJECTIVE These evidence-based guidelines developed by the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD. METHODS ASH formed a multidisciplinary panel, including 2 patient representatives, that was thoroughly vetted to minimize bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic reviews. Clinical questions and outcomes were prioritized according to importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel reached consensus on 18 recommendations specific to acute and chronic pain. The recommendations reflect a broad pain management approach, encompassing pharmacological and nonpharmacological interventions and analgesic delivery. CONCLUSIONS Because of low-certainty evidence and closely balanced benefits and harms, most recommendations are conditional. Patient preferences should drive clinical decisions. Policymaking, including that by payers, will require substantial debate and input from stakeholders. Randomized controlled trials and comparative-effectiveness studies are needed for chronic opioid therapy, nonopioid therapies, and nonpharmacological interventions.
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12
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Jonassaint CR. If you Can't Assess It, How Can you Treat It? Improving Pain Management in Sickle Cell Disease. J Emerg Nurs 2021; 47:10-15. [PMID: 33390216 DOI: 10.1016/j.jen.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
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13
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Collins AB, McTate-Acosta EA, Williams SE. The role of pain rehabilitation in an adolescent sickle cell disease population: a case series. Pediatr Hematol Oncol 2020; 37:637-644. [PMID: 32401110 DOI: 10.1080/08880018.2020.1762811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Andrew B Collins
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Pain Management, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Emily A McTate-Acosta
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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14
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Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches. Pain 2020; 160:1933-1945. [PMID: 31045749 DOI: 10.1097/j.pain.0000000000001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
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15
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Sil S, Cohen LL, Bakshi N, Watt A, Hathaway M, Abudulai F, Dampier C. Changes in Pain and Psychosocial Functioning and Transition to Chronic Pain in Pediatric Sickle Cell Disease: A Cohort Follow-up Study. Clin J Pain 2020; 36:463-471. [PMID: 32287106 PMCID: PMC7233325 DOI: 10.1097/ajp.0000000000000827] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to: (1) examine changes in pain, psychosocial functioning, and health care utilization among children and adolescents with sickle cell disease (SCD) over a 2-year period and (2) identify baseline biopsychosocial variables associated with the development and maintenance of chronic SCD pain at follow-up. MATERIALS AND METHODS Forty-two youth (8 to 18 y old) with SCD completed a battery of self-report measures at baseline and 2-year follow-up. Analgesic, Anesthetic, and Addiction Clinical Trial Translational Innovations Opportunities and Networks and American Pain Society Pain Taxonomy (AAPT) diagnostic criteria were used to categorize patients into pain frequency groups at both timepoints: chronic (pain on most [≥15] d/mo for the past 6 mo, per AAPT diagnostic criteria), episodic (pain on 1 to 14 d/mo), or asymptomatic (0 d/mo). RESULTS At baseline, 31% (n=13) had chronic pain, 50% (n=21) episodic pain, and 19% (n=8) were asymptomatic. At follow-up, 40.5% (n=17) had chronic pain, 52.4% (n=22) episodic pain, and 7.1% (n=3) were asymptomatic. Between baseline and 2-year follow-up, 12% (n=5) developed chronic SCD pain. Depressive symptoms and admissions for pain significantly increased over time for youth with chronic pain (Ps<0.05). An interaction effect revealed that baseline pain groups differed in their change in pain intensity over time (P<0.01). Baseline psychosocial factors (ie, higher functional disability, greater depressive symptoms, higher pain catastrophizing, and lower quality of life) were significantly associated with chronic pain at follow-up. DISCUSSION Biopsychosocial factors may be associated with the development and maintenance of chronic SCD pain and their relative contributions warrant further study.
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Affiliation(s)
- Soumitri Sil
- Emory University School of Medicine, Department of
Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
| | - Lindsey L. Cohen
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
- Georgia State University, Department of Psychology
| | - Nitya Bakshi
- Emory University School of Medicine, Department of
Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
| | - Amanda Watt
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
| | - Morgan Hathaway
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
| | - Farida Abudulai
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
| | - Carlton Dampier
- Emory University School of Medicine, Department of
Pediatrics
- Children’s Healthcare of Atlanta, Aflac Cancer and
Blood Disorders Center
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16
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Kingsley RA. A Healthcare Improvement Initiative to Increase Multidisciplinary Pain Management Referrals for Youth with Sickle Cell Disease. Pain Manag Nurs 2020; 21:403-409. [PMID: 32448738 DOI: 10.1016/j.pmn.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 02/18/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic pain is a complex integration of biological, psychological, and social variables. Multidisciplinary pain management experts design interventions that treat the multidimensional experience. Children and adolescents with sickle cell disease (SCD) are at risk for chronic pain. Increased risk is associated with multiple characteristics including sickle cell genotype, age, gender, frequency of hospitalization, duration of hospitalization, and certain comorbid diagnoses. Referral to pain management professionals for this population is often delayed. AIMS To increase multidisciplinary pain management referrals for youth with SCD identified to be at risk for chronic pain. DESIGN Implementation research. SETTING One pediatric, academic medical facility serving as a regional sickle cell treatment center in the Midwest. PARTICIPANTS Children greater than 2 years of age and less than 21 years of age with laboratory confirmed SCD. METHODS Implementation of an evidence-based screening tool using the consolidated framework for implementation research (CFIR) to guide project planning, design, and evaluation. The CFIR model was paired with the Plan-Do-Study-Act (PDSA) quality improvement methodology to operationalize workflow and sustain project aims. RESULTS AND CONCLUSIONS Eighty-four percent of all eligible patients were screened during their routine sickle cell appointments resulting in a 110% increase in multidisciplinary pain management referrals. Future interventions and PDSA cycles are targeted at improving attendance at scheduled appointments, reducing hospitalizations, decreasing 30-day readmissions, and shortening length of stay.
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Affiliation(s)
- Rae Ann Kingsley
- Children's Mercy Hospital, Integrative Pain Management Clinic, Kansas City, Missouri
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17
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Matthie N, Jenerette C, Gibson A, Paul S, Higgins M, Krishnamurti L. Prevalence and predictors of chronic pain intensity and disability among adults with sickle cell disease. Health Psychol Open 2020; 7:2055102920917250. [PMID: 32426150 PMCID: PMC7218472 DOI: 10.1177/2055102920917250] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Among 170 adults with sickle cell disease, we evaluated chronic pain impact and disability prevalence, assessed age and gender differences, and identified psychosocial predictors of chronic pain intensity and disability. Most participants had a high level of disability. Chronic pain intensity and disability were significantly associated with pain catastrophizing and chronic pain self-efficacy, and worsened with age. Further research is needed to confirm study findings and develop interventions, including palliative care approaches that address catastrophizing and disability, particularly for young women and middle-aged adults with sickle cell disease. Moreover, consistent clinical assessment of chronic pain and psychosocial health should be implemented.
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18
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Sil S, Lai K, Lee JL, Gilleland Marchak J, Thompson B, Cohen L, Lane P, Dampier C. Preliminary evaluation of the clinical implementation of cognitive-behavioral therapy for chronic pain management in pediatric sickle cell disease. Complement Ther Med 2020; 49:102348. [PMID: 32147059 PMCID: PMC7092728 DOI: 10.1016/j.ctim.2020.102348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Evaluate the implementation of cognitive-behavioral therapy (CBT) for chronic pain in a clinical setting by comparing youth with sickle cell disease (SCD) who initiated or did not initiate CBT. DESIGN Youth with SCD (ages 6-18; n = 101) referred for CBT for chronic pain were compared based on therapy attendance: Established Care; Early Termination; or Comparison (i.e., did not initiate CBT). SETTING Outpatient pediatric psychology and comprehensive SCD clinics in 3 locations at a southeastern children's hospital. INTERVENTIONS CBT delivery was standardized. Treatment plans were tailored to meet individualized needs. MAIN OUTCOME MEASURES Healthcare utilization included pain-related inpatient admissions, total inpatient days, and emergency department reliance (EDR) at 12-months pre-post CBT. Patient-reported outcomes (PROs) included typical pain intensity, functional disability, and coping efficacy pre-post treatment. RESULTS Adjusting for age, genotype, and hydroxyurea, early terminators of CBT had increased rates of admissions and hospital days over time relative to comparisons; those who established care had faster reduction in admissions and hospital days over time relative to comparisons. EDR decreased by 0.08 over time for Established Care and reduced by 0.01 for every 1 completed session. Patients who completed pre- and post-treatment PROs reported decreases in typical pain intensity, functional disability, and improved coping efficacy. CONCLUSIONS Establishing CBT care may support reductions in admissions for pain, length of stay, and EDR for youth with chronic SCD pain, which may be partially supported by patient-reported improvements in functioning, coping, and lower pain intensity following CBT. Enhancing clinical implementation of multidisciplinary treatments may optimize the health of these youth.
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Affiliation(s)
- Soumitri Sil
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States.
| | - Kristina Lai
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Jennifer L Lee
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Jordan Gilleland Marchak
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Beth Thompson
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Lindsey Cohen
- Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States; Georgia State University, Department of Psychology, United States
| | - Peter Lane
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
| | - Carlton Dampier
- Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States
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19
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Ford JD, Grasso DJ, Jones S, Works T, Andemariam B. Interpersonal Violence Exposure and Chronic Pain in Adult Sickle Cell Patients. JOURNAL OF INTERPERSONAL VIOLENCE 2020; 35:924-942. [PMID: 29294650 DOI: 10.1177/0886260517691521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Almost half of sickle cell disease (SCD) patients develop chronic, debilitating physical pain with uncertain genesis for which they primarily receive opiate-based palliative treatment. Psychological trauma exposure, especially interpersonal victimization, has been linked to the perception of pain in several medical diseases, but has yet to be examined in SCD patients. This study examines self-reported chronicity of pain and use of prescribed opiates in 50 adult SCD patients with and without a history of interpersonal violence exposure. We conducted a retrospective chart review of 50 consecutive SCD patients seen for medical care in an adult subspecialty hematology clinic. Data collected included demographics, opiate use, pain chronicity, and measures of anxiety, depression, and interpersonal violence exposure. Sixty-eight percent of patients reported past interpersonal violence exposure. The mean number of types of interpersonal violence exposure, including physical, sexual, or emotional abuse, was 2.76 (SD = 1.63). SCD patients with a history of interpersonal violence exposure were almost five times more likely to report chronic pain and more than six times more likely to report use of opiate-based medications on a daily basis compared with SCD patients with no history of violence exposure. Depression and anxiety symptoms were associated with violence exposure, but did not account for the relationship between violence exposure and chronic pain or prescribed opiate use. Screening and assessment of exposure to interpersonal violence may be useful in addition to screening for mental health problems in the management of chronic pain with adults diagnosed with SCD. Such screening may contribute to addressing health care disparities given the preponderance of SCD patients who are of African American ethnoracial background.
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Affiliation(s)
| | | | - Sasia Jones
- University of Connecticut Health, Farmington, USA
| | - Teresa Works
- University of Connecticut Health, Farmington, USA
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20
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Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
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Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
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21
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Relationship of Pain Quality Descriptors and Quantitative Sensory Testing: Sickle Cell Disease. Nurs Res 2019; 68:365-373. [PMID: 31283720 DOI: 10.1097/nnr.0000000000000375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Chronic pain in adults with sickle cell disease (SCD) may be the result of altered processing in the central nervous system, as indicated by quantitative sensory testing (QST). Sensory pain quality descriptors on the McGill Pain Questionnaire (MPQ) are indicators of typical or altered pain mechanisms but have not been validated with QST-derived classifications. OBJECTIVES The specific aim of this study was to identify the sensory pain quality descriptors that are associated with the QST-derived normal or sensitized classifications. We expected to find that sets of sensory pain quality descriptors would discriminate the classifications. METHODS A cross-sectional quantitative study of existing data from 186 adults of African ancestry with SCD. Variables included MPQ descriptors, patient demographic data, and QST-derived classifications. RESULTS The participants were classified as central sensitization (n = 33), mixed sensitization (n = 23), and normal sensation. Sensory pain quality descriptors that differed statistically between mixed sensitization and central sensation compared to normal sensitization included cold (p = .01) and spreading (p = .01). Aching (p = .01) and throbbing (p = .01) differed statistically between central sensitization compared with mixed sensitization and normal sensation. Beating (p = .01) differed statistically between mixed sensitization compared with central sensitization and normal sensation. No set of sensory pain quality descriptors differed statistically between QST classifications. DISCUSSION Our study is the first to examine the association between MPQ sensory pain quality descriptors and QST-derived classifications in adults with SCD. Our findings provide the basis for the development of a MPQ subscale with potential as a mechanism-based screening tool for neuropathic pain.
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22
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Dyal BW, Ezenwa MO, Yoon SL, Fillingim RB, Yao Y, Schlaeger JM, Suarez ML, Wang ZJ, Molokie RE, Wilkie DJ. A QST-based Pain Phenotype in Adults With Sickle Cell Disease: Sensitivity and Specificity of Quality Descriptors. Pain Pract 2019; 20:168-178. [PMID: 31553824 DOI: 10.1111/papr.12841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 09/09/2019] [Accepted: 09/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND We sought to refine a screening measure for discriminating a sensitized or normal sensation pain phenotype among African American adults with sickle cell disease (SCD). OBJECTIVE To develop scoring schemes based on sensory pain quality descriptors; evaluate their performance on classifying patients with SCD who had sensitization or normal sensation, and compare with scores on the Self-report Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) and the Neuropathic Pain Symptom Inventory (NPSI). METHODS Participants completed PAINReportIt, quantitative sensory testing (QST), S-LANSS, and NPSI. Conventional binary logistic regression and least absolute shrinkage and selection operator (lasso) regression were used to obtain 2 sets of weights resulting in 2 scores: the PR-Logistic (PAINReportIt score weighted by conventional binary logistic regression coefficients) and PR-Lasso (PAINReportIt score weighted by lasso regression coefficients). Performance of the proposed scores and the existing scores were evaluated. RESULTS Lasso regression resulted in a parsimonious model with non-zero weights assigned to 2 neuropathic descriptors, cold and spreading. We found positive correlations between the PR-Lasso and other scores: S-LANSS (r = 0.22, P < 0.01), NPSI (r = 0.22, P < 0.01), and PR-Logistic (r = 0.35, P < 0.01). The NPSI and PR-Lasso performed similarly at different levels of required specificity and outperformed the S-LANSS and PR-Logistic at the various specificity points. CONCLUSION The PR-Lasso offers a way to discriminate a SCD pain phenotype.
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Affiliation(s)
- Brenda W Dyal
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Miriam O Ezenwa
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Saunjoo L Yoon
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, U.S.A
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
| | - Judith M Schlaeger
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Marie L Suarez
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Zaijie J Wang
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, U.S.A
| | - Robert E Molokie
- Department of Medicine College of Medicine, University of Illinois at Chicago, Chicago, IL, U.S.A.,Jesse Brown VA Medical Center, Chicago, Illinois, U.S.A,
| | - Diana J Wilkie
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, Florida, U.S.A
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23
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Connolly ME, Bills SE, Hardy SJ. Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease. Pediatr Blood Cancer 2019; 66:e27823. [PMID: 31131984 DOI: 10.1002/pbc.27823] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/15/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pain is a major complication of sickle cell disease (SCD), spanning vaso-occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning. PROCEDURE Eighty-nine participants (ages 7-16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners-3 [Conners-third edition], and PedsQL™-SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC-V [Wechsler Intelligence Scale for Children-fifth edition], WJ-III [Woodcock Johnson Tests of Achievement-third edition], and WIAT-III [Wechsler Individual Achievement Test-third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi-square and independent sample t-test analyses were used to assess group differences (those with vs without persistent pain). RESULTS Patients with persistent pain (n = 18) reported lower health-related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026). CONCLUSIONS Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.
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Affiliation(s)
- Megan E Connolly
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
| | - Sarah E Bills
- Department of Psychology, University of South Carolina, Columbia, South Carolina
| | - Steven J Hardy
- Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC.,Divisions of Hematology and Oncology, Children's National Health System, Washington, DC
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Uhelski ML, Simone DA. Sensitization of nociceptors and dorsal horn neurons contributes to pain in sickle cell disease. Neurosci Lett 2019; 705:20-26. [PMID: 30995520 DOI: 10.1016/j.neulet.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022]
Abstract
Sickle cell disease (SCD) describes a group of disorders associated with a point mutation in the beta chain of hemoglobin. The mutation leads to the creation of sickle hemoglobin (HbS) and causes distortion of erythrocytes through polymerization under low oxygen, resulting in characteristic sickle red blood cells. Vaso-occlusion episodes caused by accumulation of sRBCs results in ischemia-reperfusion injury, reduced oxygen supply to organs, oxidative stress, organ damage and severe pain that often requires hospitalization and opioid treatment. Further, many patients suffer from chronic pain, including hypersensitivity to heat and cold stimuli. Progress towards the development of novel strategies for both acute and chronic pain in patients with SCD has been impeded by a lack of understanding the mechanisms underlying pain in SCD. The purpose of this review is to highlight evidence for the contribution of peripheral and central sensitization that leads to widespread, chronic pain and hyperalgesia. Targeting the mechanisms that initiate and maintain sensitization in SCD might offer effective approaches to manage the severe and debilitating pain associated with this condition.
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Affiliation(s)
- Megan L Uhelski
- Department of Pain Medicine, Division of Anesthesiology, Critical Care and Pain Medicine. The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
| | - Donald A Simone
- Department of Diagnostic and Biological Sciences, University of Minnesota, School of Dentistry, Minneapolis, MN 55455, United States.
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Sil S, Cohen LL, Dampier C. Pediatric pain screening identifies youth at risk of chronic pain in sickle cell disease. Pediatr Blood Cancer 2019; 66:e27538. [PMID: 30393948 PMCID: PMC6344304 DOI: 10.1002/pbc.27538] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/28/2018] [Accepted: 10/13/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND This study aimed to evaluate the preliminary validation and application of a pain screening tool to identify biopsychosocial risk factors for chronic pain in pediatric sickle cell disease (SCD) and classify youth with SCD into prognostic risk groups. METHOD Youth presenting to a pediatric SCD clinic completed the Pediatric Pain Screening Tool (PPST), a brief 9-item self-report questionnaire developed for rapid identification of risk in youth with pain complaints. Youth also completed a battery of standardized patient-reported outcomes, including pain characteristics, pain burden, functional disability, pain interference, depressive symptoms, pain catastrophizing, and fear of pain. Healthcare utilization was extracted from medical chart review. RESULTS Seventy-three 8- to 18-year-olds (94% Black, 57% female) with SCD participated. The PPST demonstrated discriminant validity that ranged from fair to excellent (area under the curves (AUC) = 0.74-0.93, P values < 0.001) for identifying significant pain frequency, disability, pain interference, and psychosocial distress. Receiver operating characteristic curve analyses indicated that previously established cutoff scores were appropriate for the SCD sample. Participants were classified into low-risk (28.8%), medium-risk (38.4%), and high-risk (32.9%) groups, with significant group differences across measures, F(18, 116) = 6.67, P < 0.001. The high-risk group reported significantly higher pain intensity, pain frequency, pain burden, functional disability, pain interference, and depressive symptoms relative to both low-risk and medium-risk groups (P values < 0.005). CONCLUSIONS The high-risk group demonstrated a pain and psychosocial profile consistent with chronic SCD pain. The PPST may be useful for efficiently identifying youth with chronic SCD pain or those at risk of poor outcomes.
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Affiliation(s)
- Soumitri Sil
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine,Children’s Healthcare of Atlanta
| | - Lindsey L. Cohen
- Children’s Healthcare of Atlanta,Georgia State University, Department of Psychology
| | - Carlton Dampier
- Aflac Cancer and Blood Disorders Center, Department of Pediatrics, Emory University School of Medicine,Children’s Healthcare of Atlanta
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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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Kapoor S, Little JA, Pecker LH. Advances in the Treatment of Sickle Cell Disease. Mayo Clin Proc 2018; 93:1810-1824. [PMID: 30414734 DOI: 10.1016/j.mayocp.2018.08.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/08/2018] [Accepted: 08/07/2018] [Indexed: 12/26/2022]
Abstract
Sickle cell disease (SCD) is a monogenic disorder that afflicts approximately 100,000 Americans and millions of people worldwide. It is characterized by hemolytic anemia, vaso-occlusive crises, relentless end-organ injury, and premature death. Currently, red blood cell transfusion and hydroxyurea are the major disease-modifying therapies available for SCD. Hematopoetic stem cell transplant is curative, but barriers to treatment are substantial and include a lack of suitable donors, immunologic transplant rejection, long-term adverse effects, prognostic uncertainty, and poor end-organ function, which is especially problematic for older patients. Gene therapy to correct the βs point mutation is under investigation as another curative modality. Deeper insights into the pathophysiology of SCD have led to the development of novel agents that target cellular adhesion, inflammation, oxidant injury, platelets and/or coagulation, vascular tone, and hemoglobin polymerization. These agents are in preclinical and clinical trials. One such agent, L-glutamine, decreases red blood cell oxidant injury and is recently US Food and Drug Administration approved to prevent acute pain episodes of SCD in patients 5 years of age or older. The purpose of this review is to describe the currently established therapies, barriers to curative therapies, and novel therapeutic agents that can target sickle cell hemoglobin polymerization and/or its downstream sequelae. A PubMed search was conducted for articles published up to May 15, 2018, using the search terms sickle cell disease, novel treatments, hematopoietic stem cell transplantation, and gene therapy. Studies cited include case series, retrospective studies, prospective clinical trials, meta-analyses, online abstracts, and original reviews.
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Affiliation(s)
- Sargam Kapoor
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Hematology/Oncology, Case Western Reserve University, Cleveland, OH
| | - Jane A Little
- Division of Hematology/Oncology, Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH; Division of Hematology/Oncology, Case Western Reserve University, Cleveland, OH
| | - Lydia H Pecker
- Division of Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD.
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Ludwig NN, Sil S, Khowaja MK, Cohen LL, Dampier C. Executive Functioning Mediates the Relationship Between Pain Coping and Quality of Life in Youth With Sickle Cell Disease. J Pediatr Psychol 2018; 43:1160-1169. [PMID: 30053072 PMCID: PMC6199175 DOI: 10.1093/jpepsy/jsy057] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023] Open
Abstract
Objective Sickle cell disease (SCD) is a lifelong condition characterized by pain, which is associated with reduced health-related quality of life (HRQL). Data suggest that patients with SCD vary in how they cope and their neurocognitive abilities. This study aimed to characterize executive functioning and pain coping styles in children with SCD experiencing a range of pain frequency (i.e., chronic, episodic, and asymptomatic) and to examine whether executive functioning mediates the relationship between pain coping and HRQL. Method Participants included 100 children and adolescents with SCD between the ages of 8 and 18 years (M = 13.53, SD = 2.8) and their parents who were recruited during outpatient SCD clinic visits in a children's hospital. Children completed questionnaires related to pain experience and pain coping. Parents completed questionnaires about demographic information, their child's executive functioning, and HRQL. Results Pain intensity, executive dysfunction, and engagement in emotion-focused coping (i.e., internalizing/catastrophizing and externalizing) predicted poor HRQL. In addition, engagement in emotion-focused coping predicted executive dysfunction. Multivariate analysis of covariance revealed executive functioning did not differ based on pain frequency; however, executive functioning was a significant mediator that helped explain the relationships between distraction and emotion-focused coping techniques on HRQL. Conclusion Findings support that executive functioning is an important factor in understanding the relationship between pain coping and HRQL in youth with SCD. Future research is warranted to examine the potential impact of executive functioning on the utility of interventions targeting adaptive pain coping in youth with SCD.
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Affiliation(s)
| | - Soumitri Sil
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
| | | | - Lindsey L Cohen
- Department of Psychology, Georgia State University
- Children’s Healthcare of Atlanta
| | - Carlton Dampier
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine
- Children’s Healthcare of Atlanta
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Matthie N, Ross D, Sinha C, Khemani K, Bakshi N, Krishnamurti L. A Qualitative Study of Chronic Pain and Self-Management in Adults with Sickle Cell Disease. J Natl Med Assoc 2018; 111:158-168. [PMID: 30266214 DOI: 10.1016/j.jnma.2018.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/06/2018] [Accepted: 08/30/2018] [Indexed: 01/08/2023]
Abstract
Acute, intermittent vaso-occlusive pain is the hallmark of sickle cell disease (SCD) and is associated with substantial morbidity and impaired quality of life (QOL). The subgroup of adults with SCD who transition from recurrent, acute pain to chronic, persistent pain have even greater QOL impairment and higher rates of healthcare utilization. Self-management is central to SCD management; however, its role in chronic pain management is not established. This qualitative study was conducted to answer the following research questions: (1) What is the chronic pain experience of adults with SCD? (2) What self-management strategies do adults with SCD use for chronic pain? and (3) Do adults with SCD have any needs in the self-management of chronic pain? Eighteen Black adults with SCD completed a demographics questionnaire and an interview. The majority of the participants were 21-30 years of age (mean 33.5, SD 7.6), female (61.1%), employed at least part-time (61.1%), single/never married (72.2%), and had a SCD type of sickle cell anemia (55.5%). Interview analysis revealed three major themes: (1) the chronic pain experience; (2) strategies for managing chronic pain; and (3) challenges and needs in managing chronic pain. Study findings can be used to support chronic pain management among adults with SCD. Further research is needed to devise and implement effective strategies for the prevention and management of chronic SCD pain.
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Affiliation(s)
- Nadine Matthie
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
| | - Diana Ross
- Emory University, School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Cynthia Sinha
- Emory University, School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Kirshma Khemani
- Emory University, School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
| | - Nitya Bakshi
- Emory University, School of Medicine, 100 Woodruff Circle, Atlanta, GA 30322, USA
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30
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Mendes PMV, Bezerra DLC, Dos Santos LR, de Oliveira Santos R, de Sousa Melo SR, Morais JBS, Severo JS, Vieira SC, do Nascimento Marreiro D. Magnesium in Breast Cancer: What Is Its Influence on the Progression of This Disease? Biol Trace Elem Res 2018; 184:334-339. [PMID: 29198048 DOI: 10.1007/s12011-017-1207-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022]
Abstract
Breast cancer is a disease of high mortality, characterized by the progressive accumulation of mutations that contribute to the uncontrolled development of breast tissue cells. Literature shows that disturbances in mineral homeostasis, such as magnesium, may interfere with tumor progression. The objective of this study is to provide updated information about magnesium's role in the pathogenesis of breast cancer. A review of literature was carried out from a search for articles in the PubMed and CAPES Periodicals databases published between 1995 and 2016 with the cross-references of the descriptors "magnesium," "breast neoplasms," and "oxidative stress" and the corresponding words in Portuguese. We included studies on the metabolism and bioavailability of magnesium and studies related to breast cancer and excluded articles in which only the abstract was available, dissertations, theses, articles involving adjuvant and/or neoadjuvant therapies, and supplementation of minerals in breast cancer patients. Magnesium is a mineral that participates in the metabolism of various nutrients and nucleic acids. In the presence of breast cancer, neoplastic cells increase the expression of magnesium transport channels, which raises the intracellular concentration of the mineral, contributing to tumor growth through its function of increasing energy demand. The data obtained in this review illustrates the influence of magnesium on the progression of breast cancer. However, the existing data are scarce and inconsistent, which demonstrates a need for further studies on the subject with a goal to have better control of the disease.
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Affiliation(s)
- Priscyla Maria Vieira Mendes
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Daila Leite Chaves Bezerra
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Loanne Rocha Dos Santos
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Raísa de Oliveira Santos
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Stéfany Rodrigues de Sousa Melo
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Jennifer Beatriz Silva Morais
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Juliana Soares Severo
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil
| | - Sabas Carlos Vieira
- Department of Medicine, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Teresina, PI, Brazil
| | - Dilina do Nascimento Marreiro
- Department of Nutrition, Federal University of Piauí, Ministro Petrônio Portella Campus, Ininga, Rua Hugo Napoleão, 665, Ed. Palazzo Reale, Apt°. 2001, Jóquei, Teresina, PI, CEP 64048-320, Brazil.
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31
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Cataldo G, Lunzer MM, Olson JK, Akgün E, Belcher JD, Vercellotti GM, Portoghese PS, Simone DA. Bivalent ligand MCC22 potently attenuates nociception in a murine model of sickle cell disease. Pain 2018; 159:1382-1391. [PMID: 29578946 PMCID: PMC6008209 DOI: 10.1097/j.pain.0000000000001225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Sickle cell disease (SCD) is a chronic inflammatory disorder accompanied by chronic pain. In addition to ongoing pain and hyperalgesia, vaso-occlusive crises-induced pain can be chronic or episodic. Because analgesics typically used to treat pain are not very effective in SCD, opioids, including morphine, are a primary treatment for managing pain in SCD but are associated with many serious side effects, including constipation, tolerance, addiction, and respiratory depression. Thus, there is a need for the development of novel treatments for pain in SCD. In this study, we used the Townes transgenic mouse model of SCD to investigate the antinociceptive efficacy of the bivalent ligand, MCC22, and compared its effectiveness with morphine. MCC22 consists of a mu-opioid receptor agonist and a chemokine receptor-5 (CCR5) antagonist that are linked through a 22-atom spacer. Our results show that intraperitoneal administration of MCC22 produced exceptionally potent dose-dependent antihyperalgesia as compared to morphine, dramatically decreased evoked responses of nociceptive dorsal horn neurons, and decreased expression of proinflammatory cytokines in the spinal cord. Moreover, tolerance did not develop to its analgesic effects after repeated administration. In view of the extraordinary potency of MCC22 without tolerance, MCC22 and similar compounds may vastly improve the management of pain associated with SCD.
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Affiliation(s)
- Giuseppe Cataldo
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Mary M. Lunzer
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Julie K. Olson
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Eyup Akgün
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - John D. Belcher
- Department of Medicine, Vascular Biology Center, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Gregory M. Vercellotti
- Department of Medicine, Vascular Biology Center, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Philip S. Portoghese
- Department of Medicinal Chemistry, College of Pharmacy, University of Minnesota, Minneapolis, MN
| | - Donald A. Simone
- Department of Diagnostic & Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
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Affiliation(s)
- Steven E. Harte
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Richard E. Harris
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
| | - Daniel J. Clauw
- Department of Anesthesiology Chronic Pain and Fatigue Research Center University of Michigan Ann Arbor Michigan
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Chang AK, Ginter Summarell CC, Birdie PT, Sheehan VA. Genetic modifiers of severity in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:147-164. [PMID: 29614629 DOI: 10.3233/ch-189004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Sickle cell disease (SCD) is one of the most common single disease disorders world-wide. It is remarkable for its clinical heterogeneity, even among individuals with identical genotypes. Some individuals experience morbidity and mortality in early childhood, while others have a relatively mild course, and normal or near normal life expectancy. Many clinical complications are associated with SCD; most notably frequent pain episodes, stroke, acute chest syndrome, avascular necrosis, nephropathy, retinopathy and pulmonary hypertension. While the effects of higher fetal hemoglobin (HbF) levels, UGTA1A polymorphisms, alpha-thalassemia and G6PD deficiency on SCD has been extensively studied, these variables do not explain all of the clinical heterogeneity of SCD. It is not known why some patients develop certain complications, and it is difficult to predict which complications a particular patient will experience. Much work has been done to identify genetic variants associated with these disease complications; many associations remain unvalidated. As the field continues to move beyond small sample collections and candidate gene approaches into whole genome sequencing and merging of samples from all over the world, we will identify more genetic variants associated with development of specific SCD related complications, and hopefully leverage this knowledge into targeted therapies.
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Affiliation(s)
- Alicia K Chang
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Carly C Ginter Summarell
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Parendi T Birdie
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
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Sensitization of C-fiber nociceptors in mice with sickle cell disease is decreased by local inhibition of anandamide hydrolysis. Pain 2018; 158:1711-1722. [PMID: 28570479 DOI: 10.1097/j.pain.0000000000000966] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Chronic pain and hyperalgesia, as well as pain resulting from episodes of vaso-occlusion, are characteristic features of sickle cell disease (SCD) and are difficult to treat. Since there is growing evidence that increasing local levels of endocannabinoids can decrease hyperalgesia, we examined the effects of URB597, a fatty acid amide hydrolase (FAAH) inhibitor, which blocks the hydrolysis of the endogenous cannabinoid anandamide, on hyperalgesia and sensitization of cutaneous nociceptors in a humanized mouse model of SCD. Using homozygous HbSS-BERK sickle mice, we determined the effects of URB597 on mechanical hyperalgesia and on sensitization of C-fiber nociceptors in vivo. Intraplantar administration of URB597 (10 μg in 10 μL) decreased the frequency of withdrawal responses evoked by a von Frey monofilament (3.9 mN bending force) applied to the plantar hind paw. This was blocked by the CB1 receptor antagonist AM281 but not by the CB2 receptor antagonist AM630. Also, URB597 decreased hyperalgesia in HbSS-BERK/CB2R sickle mice, further confirming the role of CB1 receptors in the effects produced by URB597. Electrophysiological recordings were made from primary afferent fibers of the tibial nerve in anesthetized mice. The proportion of Aδ- and C-fiber nociceptors that exhibited spontaneous activity and responses of C-fibers to mechanical and thermal stimuli were greater in HbSS-BERK sickle mice as compared to control HbAA-BERK mice. Spontaneous activity and evoked responses of nociceptors were decreased by URB597 via CB1 receptors. It is suggested that enhanced endocannabinoid activity in the periphery may be beneficial in alleviating chronic pain associated with SCD.
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Darbari DS, Liljencrantz J, Ikechi A, Martin S, Roderick MC, Fitzhugh CD, Tisdale JF, Thein SL, Hsieh M. Pain and opioid use after reversal of sickle cell disease following HLA-matched sibling haematopoietic stem cell transplant. Br J Haematol 2018. [PMID: 29527656 DOI: 10.1111/bjh.15169] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Deepika S Darbari
- Division of Hematology and Oncology, Children's National Medical Center, Washington, DC, USA.,The George Washington University School of Medicine, Washington, DC, USA.,Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - Jaquette Liljencrantz
- National Institutes of Health, Bethesda, MD, USA.,Pain and Integrative Neuroscience Laboratory, National Center for Complementary and Integrative Health, Bethesda, MD, USA
| | | | - Staci Martin
- National Institutes of Health, Bethesda, MD, USA.,National Cancer Institute, Rockville, MD, USA
| | - Marie Claire Roderick
- National Institutes of Health, Bethesda, MD, USA.,National Cancer Institute, Rockville, MD, USA
| | - Courtney D Fitzhugh
- Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - John F Tisdale
- National Institutes of Health, Bethesda, MD, USA.,Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.,National Institutes of Health, Bethesda, MD, USA
| | - Matthew Hsieh
- National Institutes of Health, Bethesda, MD, USA.,Molecular and Clinical Hematology Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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36
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Darbari DS, Brandow AM. Pain-measurement tools in sickle cell disease: where are we now? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:534-541. [PMID: 29222302 PMCID: PMC6142608 DOI: 10.1182/asheducation-2017.1.534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pain is a complex multidimensional experience and the most common morbidity in patients with sickle cell disease (SCD). Tools to assess pain can be of use not only to guide pain treatment but also to provide insight into underlying pain neurobiology. Mechanisms of pain in SCD are multifactorial and are not completely elucidated. Although vaso-occlusion of microcirculation by sickled red cells is believed to be the underlying mechanism of acute vaso-occlusive pain, mechanisms for chronic pain and the transition from acute to chronic pain are under investigation. A number of modalities can be used in clinical practice and/or research to capture various dimensions of pain. Selection of a pain-assessment tool should be directed by the purpose of the assessment. Pain-assessment tools, many of which are currently in the early stages of validation, are discussed here. Development and validation of these multimodal tools is crucial for developing improved understanding of SCD pain and its management.
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Affiliation(s)
- Deepika S Darbari
- Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Amanda M Brandow
- Section of Pediatric Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI; and
- Children's Research Institute, Children's Hospital of Wisconsin, Milwaukee, WI
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Karlson CW, Baker AM, Bromberg MH, David Elkin T, Majumdar S, Palermo TM. Daily Pain, Physical Activity, and Home Fluid Intake in Pediatric Sickle Cell Disease. J Pediatr Psychol 2017; 42:335-344. [PMID: 27370016 DOI: 10.1093/jpepsy/jsw061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/07/2016] [Indexed: 01/11/2023] Open
Abstract
Objectives This study examined the temporal relationship between physical activity, fluid intake, and daily pain in children with sickle cell disease (SCD) with frequent pain. Methods A total of 30 African American children ( M age = 13.9; 53% female; 76.3% type SS) who reported pain more than or equal to once every 2 weeks and their parents completed measures of pain and anxiety/depressive symptoms. Children then completed a daily pain diary and wore a physical activity Actiwatch for 14 days at home. Results Contrary to physiological theory-based hypotheses, lower physical activity was associated with greater pain during the same day and the next day. Less pain was associated with greater physical activity the next day. There was no relationship between self-reported home fluid intake and daily pain ( p 's < .05). Conclusions Results lend support for a complex bidirectional relationship between physical activity and daily pain in pediatric SCD, and identify physical activity as a target for future research.
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Affiliation(s)
- Cynthia W Karlson
- Division of Hematology-Oncology, Department of Pediatrics, University of Mississippi Medical Center, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, MS, USA
| | - Anna M Baker
- Adherence Research Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Maggie H Bromberg
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, M/S CW8-6, Seattle, WA, USA
| | - Thomas David Elkin
- Division of Hematology-Oncology, Department of Pediatrics, University of Mississippi Medical Center, MS, USA.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, MS, USA
| | - Suvankar Majumdar
- Division of Hematology-Oncology, Department of Pediatrics, University of Mississippi Medical Center, MS, USA
| | - Tonya M Palermo
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, M/S CW8-6, Seattle, WA, USA.,Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Holloway BM, McGill LS, Bediako SM. Depressive symptoms and sickle cell pain: The moderating role of internalized stigma. STIGMA AND HEALTH 2017; 2:271-280. [PMID: 29404408 DOI: 10.1037/sah0000060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Recent studies describe the clinical implications of sickle cell disease (SCD) stigma. However, little is known about its link to depressive symptoms or its relative influence on the association between depressive symptoms and SCD pain. We examined whether internalized stigma about SCD moderated the relation between depressive symptoms and pain among 69 adults attending a SCD clinic who reported pain episodes and healthcare use over the past three months. Unadjusted bivariate analyses showed a marginal association between depressive symptoms and SCD pain frequency (r = .21, p < .10). Further analyses adjusting for health care use indicated a moderating effect of internalized stigma (b = -.10, p < .05): a significant association between depressive symptoms and pain was observed among participants low in internalized stigma, but this relationship was attenuated at moderate and high stigma levels. These results denote counterintuitive consequences of internalized attitudes about SCD and suggest a need for further study of the psychosocial and clinical implications of SCD stigma.
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Affiliation(s)
| | - Lakeya S McGill
- Department of Psychology, University of Maryland, Baltimore County
| | - Shawn M Bediako
- Department of Psychology, University of Maryland, Baltimore County
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Darbari DS, Vaughan KJ, Roskom K, Seamon C, Diaw L, Quinn M, Conrey A, Schechter AN, Haythornthwaite JA, Waclawiw MA, Wallen GR, Belfer I, Taylor JG. Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia. Scand J Pain 2017; 17:279-286. [PMID: 28969994 PMCID: PMC5726893 DOI: 10.1016/j.sjpain.2017.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/26/2017] [Accepted: 08/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Pain is the hallmark of sickle cell anemia (SCA), presenting as recurrent acute events or chronic pain. Central sensitization, or enhanced excitability of the central nervous system, alters pain processing and contributes to the maintenance of chronic pain. Individuals with SCA demonstrate enhanced sensitivity to painful stimuli however central mechanisms of pain have not been fully explored. We hypothesized that adults with SCA would show evidence of central sensitization as observed in other diseases of chronic pain. METHODS We conducted a prospective study of static and dynamic quantitative sensory tests in 30 adults with SCA and 30 matched controls. RESULTS Static thermal testing using cold stimuli showed lower pain thresholds (p=0.04) and tolerance (p=0.04) in sickle cell subjects, but not for heat. However, SCA subjects reported higher pain ratings with random heat pulses (p<0.0001) and change in scores with temporal summation at the heat pain threshold (p=0.002). Similarly, with the use of pressure pain stimuli, sickle cell subjects reported higher pain ratings (p=0.04), but not higher pressure pain tolerance/thresholds or allodynia to light tactile stimuli. Temporal summation pain score changes using 2 pinprick probes (256 and 512mN) were significantly greater (p=0.004 and p=0.008) with sickle cell, and delayed recovery was associated with lower fetal hemoglobin (p=0.002 and 0.003). CONCLUSIONS Exaggerated temporal summation responses provide evidence of central sensitization in SCA. IMPLICATIONS The association with fetal hemoglobin suggests this known SCA modifier may have a therapeutic role in modulating central sensitization.
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Affiliation(s)
- Deepika S Darbari
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Center for Cancer and Blood Diseases, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Kathleen J Vaughan
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Katherine Roskom
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cassie Seamon
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lena Diaw
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Meghan Quinn
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Conrey
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alan N Schechter
- Molecular Biology and Genetics Section, Molecular Medicine Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer A Haythornthwaite
- Center for Mind-Body Research, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Myron A Waclawiw
- Office of Biostatistics Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Gwenyth R Wallen
- National Institutes of Health, Clinical Center, Bethesda, MD, USA
| | - Inna Belfer
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - James G Taylor
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA; Department of Medicine and Center for Sickle Cell Disease, Howard University College of Medicine, Washington, DC, USA.
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Brandalise SR, Assis R, Laranjeira ABA, Yunes JA, de Campos-Lima PO. Low-dose methotrexate in sickle-cell disease: a pilot study with rationale borrowed from rheumatoid arthritis. Exp Hematol Oncol 2017. [PMID: 28638723 PMCID: PMC5474854 DOI: 10.1186/s40164-017-0078-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Inflammation is a major feature of sickle cell disease (SCD). Low-dose methotrexate (MTX) has long been used in chronic inflammatory diseases. This pilot study examined the MTX effect on acute vaso-occlusive pain crises (VOC) in SCD patients. Methods Fourteen adults on hydroxyurea with severe and refractory VOC received one intramuscular injection of 10 mg of MTX per week for 12 weeks. A single weekly dose of 5 mg of leucovorin was administered orally 48 h after each MTX injection. The primary outcome was reduction in number/intensity of acute pain episodes. The secondary outcomes were improvement of quality of life (QOL) and reduction of the inflammatory status. Results MTX did not significantly change the median VOC frequency (12 before vs 10.5 during treatment, P = 0.6240) or the median McGill pain index (45 at week 0 vs 39.5 at week 12, P = 0.9311). However, there was a decrease of ≥50% in chronic pain resulting from avascular osteonecrosis (AVN) in 5 out of 7 patients with radiologic evidence of AVN, with the perception of longer pain-free periods. There was a 44.4% median gain in physical function in the SF-36 QOL questionnaire (P = 0.0198). MTX treatment up-regulated two C-X-C motif chemokines (CXCL), CXCL10 (P = 0.0463) and CXCL12 (P < 0.0001), without significant effect on 14 additional plasma inflammatory markers. Adverse events: One individual had fever of unknown origin. Respiratory tract infections were recorded in five patients. Among the latter, one also had dengue fever and another had a central venous line infection and died of pneumonia and septic shock. Three patients with previous history of hydroxyurea-induced hematological toxicity developed low blood platelet counts while receiving simultaneously MTX and hydroxyurea. Conclusions Although MTX did not reduce acute VOC frequency/intensity, it decreased chronic pain and led to QOL improvement. Trial registrationhttp://www.who.int/ictrp/en/ and http://www.ensaiosclinicos.gov.br, RBR-2s9xvn, 19 December 2016, retrospectively registered Electronic supplementary material The online version of this article (doi:10.1186/s40164-017-0078-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silvia R Brandalise
- Boldrini Children's Center, Rua Dr. Gabriel Porto 1270, Cidade Universitaria, Campinas, SP 13083-210 Brazil.,Department of Pediatrics, School of Medicine, State University of Campinas, Campinas, SP Brazil
| | - Rosemary Assis
- Department of Psychology, Paulista University, Campinas, SP Brazil
| | | | - José Andrés Yunes
- Boldrini Children's Center, Rua Dr. Gabriel Porto 1270, Cidade Universitaria, Campinas, SP 13083-210 Brazil
| | - Pedro O de Campos-Lima
- Boldrini Children's Center, Rua Dr. Gabriel Porto 1270, Cidade Universitaria, Campinas, SP 13083-210 Brazil
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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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Abstract
BACKGROUND Sickle cell disease (SCD) is primarily characterized by pain. This chronic pain with acute exacerbations is the most common reason for hospital visits, admissions, and readmissions, particularly in young adults (aged 18–39 years). People who present to the hospital for pain crises often report that nurses lack knowledge of SCD and, consequently, they do not provide appropriate, timely care. OBJECTIVES Because pain episodes often result in hospital admissions, this article highlights prominent issues that staff nurses need to know. METHODS Using a review of the literature and case studies, the authors provide recommendations to improve care of adults with SCD. FINDINGS No objective signs of a sickle cell pain crisis exist. Patients react to pain in different ways and use various coping mechanisms in response. Suspected opioid addiction should not affect the provision of nursing care. Pain must be treated appropriately to decrease the potential for prolonged admissions and/or readmissions. Patients are to be acknowledged as experts and collaborated with in developing an appropriate plan of care. Advocacy on behalf of the patient is important for better communication with providers. With this knowledge, nurses will be better equipped to provide the appropriate and timely care required to manage pain crises experienced by individuals living with SCD.
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Mathur VA, Kiley KB, Carroll CP, Edwards RR, Lanzkron S, Haythornthwaite JA, Campbell CM. Disease-Related, Nondisease-Related, and Situational Catastrophizing in Sickle Cell Disease and Its Relationship With Pain. THE JOURNAL OF PAIN 2016; 17:1227-1236. [PMID: 27555427 DOI: 10.1016/j.jpain.2016.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/28/2016] [Accepted: 08/10/2016] [Indexed: 02/02/2023]
Abstract
Catastrophizing is a potent psychological modulator of pain across several chronic pain populations; yet despite evidence that patients with sickle cell disease (SCD) catastrophize more than patients with other chronic pain conditions, previous research indicates that catastrophizing is not related to sickle cell pain after controlling for relevant covariates such as depression. Recent research suggests that pain-related catastrophizing should be assessed across pain contexts (eg, dispositional and situational). In this study, we measured disease-specific, general non-disease-related, and situational catastrophizing and assessed the relationship between these contextual dimensions of catastrophizing and laboratory and clinical pain among patients with SCD. Results revealed differential catastrophizing across pain contexts, with patients reporting greater catastrophizing about SCD-specific pain compared with non-SCD pain and laboratory pain. SCD-specific and non-SCD catastrophizing were associated with clinical pain outcomes, and situational catastrophizing with markers of central sensitization and laboratory pain. Further examination of the time course of laboratory responses revealed that increases in situational catastrophizing were associated with subsequent increases in laboratory pain sensitivity. Taken together, results show the relevance of catastrophizing in understanding pain in SCD, and suggest that context-specific anchors may be beneficial in predicting different aspects of the pain experience (eg, chronic pain, pain sensitization). PERSPECTIVE Patients with SCD report greater catastrophizing about sickle cell-specific pain relative to other pains. Disease-specific and non-disease-related pain catastrophizing were associated with clinical pain, and situational catastrophizing predictive of subsequent laboratory pain. Evaluation of context-specific catastrophizing may more accurately predict different aspects of the pain experience.
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Affiliation(s)
- Vani A Mathur
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Psychology, Texas A&M University, College Station, Texas.
| | - Kasey B Kiley
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert R Edwards
- Departments of Anesthesiology, Perioperative, Pain Medicine, and Psychiatry, Harvard Medical School; and Pain Management Center, Brigham and Women's Hospital, Chestnut Hill, Massachusetts
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cataldo G, Rajput S, Gupta K, Simone DA. Sensitization of nociceptive spinal neurons contributes to pain in a transgenic model of sickle cell disease. Pain 2015; 156:722-730. [PMID: 25630029 DOI: 10.1097/j.pain.0000000000000104] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic pain is a major characteristic feature of sickle cell disease (SCD). The refractory nature of pain and the development of chronic pain syndromes in many patients with SCD suggest that central neural mechanisms contribute to pain in this disease. We used HbSS-BERK sickle mice, which show chronic features of pain similar to those observed in SCD, and determined whether sensitization of nociceptive neurons in the spinal cord contributes to pain and hyperalgesia in SCD. Electrophysiological recordings of action potential activity were obtained from single identified dorsal horn neurons of the spinal cord in anesthetized mice. Compared with control HbAA-BERK mice, nociceptive dorsal horn neurons in sickle mice exhibited enhanced excitability as evidenced by enlarged receptive fields, increased rate of spontaneous activity, lower mechanical thresholds, enhanced responses to mechanical stimuli, and prolonged afterdischarges following mechanical stimulation. These changes were accompanied by increased phosphorylation of mitogen-activated protein kinases (MAPKs) in the spinal cord that are known to contribute to neuronal hyperexcitability, including c-Jun N-terminal kinase (JNK), p44/p42 extracellular signaling-regulated kinase (ERK), and p38. These findings demonstrate that central sensitization contributes to pain in SCD.
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Affiliation(s)
- Giuseppe Cataldo
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, USA
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Darbari DS, Hampson JP, Ichesco E, Kadom N, Vezina G, Evangelou I, Clauw DJ, Taylor Vi JG, Harris RE. Frequency of Hospitalizations for Pain and Association With Altered Brain Network Connectivity in Sickle Cell Disease. THE JOURNAL OF PAIN 2015; 16:1077-86. [PMID: 26291276 PMCID: PMC4986827 DOI: 10.1016/j.jpain.2015.07.005] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/11/2015] [Accepted: 07/28/2015] [Indexed: 12/23/2022]
Abstract
UNLABELLED Sickle cell disease (SCD) is a hemoglobinopathy that affects more than 100,000 individuals in the United States. The disease is characterized by the presence of sickle hemoglobin and recurrent episodes of pain. Some individuals with SCD experience frequent hospitalizations and a high burden of pain. The role of central mechanisms in SCD pain has not been explored. Twenty-five adolescents and young adults with SCD underwent functional magnetic resonance imaging. Participants were stratified into groups with high pain or low pain based on the number of hospitalizations for pain in the preceding 12 months. Resting state functional connectivity was analyzed using seed-based and dual regression independent component analysis. Intrinsic brain connectivity was compared between the high pain and low pain groups, and association with fetal hemoglobin, a known modifier of SCD, was explored. Patients in the high pain group displayed an excess of pronociceptive connectivity such as between anterior cingulate and default mode network structures, such as the precuneus, whereas patients in the low pain group showed more connectivity to antinociceptive structures such as the perigenual and subgenual cingulate. Although a similar proportion of patients in both groups reported that they were on hydroxyurea, the fetal hemoglobin levels were significantly higher in the low pain group and were associated with greater connectivity to antinociceptive structures. These findings support the role of central mechanisms in SCD pain. Intrinsic brain connectivity should be explored as a complementary and objective outcome measure in SCD pain research. PERSPECTIVE Altered connectivity patterns associated with high pain experience in patients with sickle cell disease suggest a possible role of central mechanisms in sickle cell pain. Resting state brain connectivity studies should be explored as an effective methodology to investigate pain in SCD.
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Affiliation(s)
- Deepika S Darbari
- Division of Hematology, Center for Cancer and Blood Disorders, Children's National Health System, Washington, DC; Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.
| | - Johnson P Hampson
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Eric Ichesco
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Nadja Kadom
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts
| | - Gilbert Vezina
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC; Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia
| | - Iordanis Evangelou
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland; Department of Diagnostic Imaging and Radiology, Children's National Health System, Washington, District of Columbia
| | - Daniel J Clauw
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - James G Taylor Vi
- Genomic Medicine Section, Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
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Matthie N, Hamilton J, Wells D, Jenerette C. Perceptions of young adults with sickle cell disease concerning their disease experience. J Adv Nurs 2015; 72:1441-51. [PMID: 26350494 DOI: 10.1111/jan.12760] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2015] [Indexed: 01/19/2023]
Abstract
AIM To describe the perceptions of young adults with sickle cell disease concerning their disease experience. BACKGROUND Sickle cell disease is a lifelong, genetic condition with both acute and chronic painful exacerbations. Little is known of the experiences of young adults with sickle cell disease. DESIGN This study used a qualitative, descriptive design with semi-structured, life review interviews. METHODS Between August 2010-September 2012, purposive sampling was used to recruit participants with a known sickle cell disease diagnosis who were ages 18-35 years, were being seen in an outpatient sickle cell clinic and were English speaking. Participants provided demographic information and responded to two interviews. A content analysis was then used to interpret participants' narratives of their experiences of living with sickle cell disease. RESULTS/FINDINGS A sample of 29 young adults with sickle cell disease consisted of 79·3% females, 35·6% employed full-time or part-time, 71·6% single/never married and 57·8% with sickle cell anaemia. Their mean age was 25·8 with 13·2 years of education. Four major interview themes were identified: (1) struggles to maintain or achieve good quality of life or life satisfactions; (2) strategies to maintain self-care; (3) interruptions to family, work and social roles; and (4) difficulties accessing needed health care. CONCLUSION Young adults face many challenges while living with sickle cell disease. With a better understanding of their disease experience and how it influences their quality of life, researchers can begin tailoring appropriate interventions to improve health outcomes in this vulnerable, minority population.
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Affiliation(s)
- Nadine Matthie
- University of North Carolina at Chapel Hill, School of Nursing, North Carolina, USA
| | - Jill Hamilton
- Johns Hopkins University, School of Nursing, Baltimore, Maryland, USA
| | - Diana Wells
- University of North Carolina at Chapel Hill, School of Medicine, North Carolina, USA
| | - Coretta Jenerette
- University of North Carolina at Chapel Hill, School of Nursing, North Carolina, USA
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Vang D, Paul JA, Nguyen J, Tran H, Vincent L, Yasuda D, Zaveri NT, Gupta K. Small-molecule nociceptin receptor agonist ameliorates mast cell activation and pain in sickle mice. Haematologica 2015; 100:1517-25. [PMID: 26294734 DOI: 10.3324/haematol.2015.128736] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/17/2015] [Indexed: 01/04/2023] Open
Abstract
Treatment of pain with morphine and its congeners in sickle cell anemia is suboptimal, warranting the need for analgesics devoid of side effects, addiction and tolerance liability. Small-molecule nociceptin opioid receptor ligands show analgesic efficacy in acute and chronic pain models. We show that AT-200, a high affinity nociceptin opioid receptor agonist with low efficacy at the mu opioid receptor, ameliorated chronic and hypoxia/reoxygenation-induced mechanical, thermal and deep tissue/musculoskeletal hyperalgesia in HbSS-BERK sickle mice. The antinociceptive effect of AT-200 was antagonized by SB-612111, a nociceptin opioid receptor antagonist, but not naloxone, a non-selective mu opioid receptor antagonist. Daily 7-day treatment with AT-200 did not develop tolerance and showed a sustained anti-nociceptive effect, which improved over time and led to reduced plasma serum amyloid protein, neuropeptides, inflammatory cytokines and mast cell activation in the periphery. These data suggest that AT-200 ameliorates pain in sickle mice via the nociceptin opioid receptor by reducing inflammation and mast cell activation without causing tolerance. Thus, nociceptin opioid receptor agonists are promising drugs for treating pain in sickle cell anemia.
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Affiliation(s)
- Derek Vang
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jinny A Paul
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Julia Nguyen
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Huy Tran
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Lucile Vincent
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Kalpna Gupta
- Vascular Biology Center and Division of Hematology-Oncology-Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Matthie N, Brewer CA, Moura VL, Jenerette CM. Breathing Exercises for Inpatients with Sickle Cell Disease. MEDSURG NURSING : OFFICIAL JOURNAL OF THE ACADEMY OF MEDICAL-SURGICAL NURSES 2015; 24:35-38. [PMID: 26306354 PMCID: PMC5363956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sickle cell disease (SCD) is a painful condition wherein breathing often is compromised. This pilot study supports the premise that individuals with SCD are willing to learn breathing exercises. Medical-surgical nurses should encourage breathing exercises for managing pain and preventing complications.
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