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Jagtiani A, Chou E, Gillespie SE, Liu K, Krishnamurti L, McClish D, Smith WR, Bakshi N. High-impact chronic pain in sickle cell disease: insights from the Pain in Sickle Cell Epidemiology Study (PiSCES). Pain 2024:00006396-990000000-00609. [PMID: 38787626 DOI: 10.1097/j.pain.0000000000003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/15/2024] [Indexed: 05/26/2024]
Abstract
ABSTRACT The US National Pain Strategy recommends identifying individuals with chronic pain (CP) who experience substantial restriction in work, social, or self-care activities as having high-impact chronic pain (HICP). High-impact chronic pain has not been examined among individuals with CP and sickle cell disease (SCD). We analyzed data from 63 individuals with SCD and CP who completed at least 5 months of pain diaries in the Pain in Sickle Cell Epidemiology Study (PiSCES). Forty-eight individuals met the definition for HICP, which was operationalized in this study as reporting pain interference on more than half of diary days. Compared with individuals without HICP, individuals with HICP experienced higher mean daily pain intensity, particularly on days without crises. They also experienced a greater proportion of days with pain, days with healthcare utilization, and days with home opioid use and higher levels of stress. They did not have a statistically significantly higher proportion of days with crises or experience higher mean daily pain intensity on days with crises. Individuals with HICP experienced worse physical functioning and worse physical health compared with those without HICP, controlling for mean pain intensity, age, sex, and education. The results of this study support that HICP is a severely affected subgroup of those with CP in SCD and is associated with greater pain burden and worse health outcomes. The findings from this study should be confirmed prospectively in a contemporary cohort of individuals with SCD.
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Affiliation(s)
- Ashna Jagtiani
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Eric Chou
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Scott E Gillespie
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University, Atlanta, Georgia, United States
| | - Katie Liu
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University, Atlanta, Georgia, United States
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Donna McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Wally R Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
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Sisler I, McClish DK, Villella A, Valrie C, Smith WR. Impact of community health workers on quality of life in adolescents and young adults with sickle cell disease: The SHIP-HU study. Br J Haematol 2024; 204:649-657. [PMID: 37779237 DOI: 10.1111/bjh.19113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 10/03/2023]
Abstract
Health-related quality of life (HRQoL) is an important outcome for patients with sickle cell disease (SCD). It is often poor compared with other chronic medical conditions or measured as a multidomain disease-specific construct. We previously reported outcomes in the Start Healing in Patients with Hydroxyurea (SHIP-HU) randomized controlled trial in adolescents and adults with SCD at six clinical sites. Besides the primary outcomes, we also measured HRQoL as a secondary outcome. Patients in the intervention arm were each assigned community health workers (CHWs) who provided case management services. CHW services were independent of medical management, and medical managers were blinded to the study arm. Patients in the control arm received only standard of care. We hypothesized that having a CHW would improve HRQoL in patients enrolled in SHIP-HU. We did not find significant differences between domains of HRQoL in the two study arms. Possible explanations include selection bias of enrolled versus unenrolled patients, selection bias of sites, medical providers and medical management, enforced blinding, and a lack of cooperation between medical managers and CHWs. The importance of CHWs and HRQoL is nonetheless recognized based on the literature. Future interventions on HRQoL in SCD should consider alternative study designs and multimodal interventions.
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Affiliation(s)
- India Sisler
- Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virigina, USA
| | - Donna K McClish
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
| | - Anthony Villella
- Department of Hematology and Oncology, Nationwide Children's Hospital Hematology Oncology & Blood and Marrow Transplant, Columbus, Ohio, USA
| | - Cecelia Valrie
- Department of Psychology, Virginia Commonwealth University, Richmond, Virigina, USA
| | - Wally R Smith
- Health Care System, Virginia Commonwealth University Health System, Richmond, Virigina, USA
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