Pain in sickle cell disease is poorly recognized, measured, and treated. Although painful episodes are the most common reason sickle cell patients seek care, studies have seldom directly measured pain in detail. In studies to date, biological and demographic variables alone only partly explain the observed variance in painful episode frequency. Further, little is known about differences in pain responses including home management versus health care utilization.
Aims of this cohort study are to measure the variability in pain and response to pain in sickle cell disease, and to build multivariate models to explain both patients' pain and their response to pain, especially, utilization of health care. The models' outcome variables will include mean pain, painful episodes, and various types of utilization episodes, including non-narcotic analgesic use, narcotic use, office visits, emergency department (ED visits, and hospitalization. An additional outcome will be the percentage of each patient's painful episodes that result in various types of utilization. Outcomes will be operationalized using daily pain diaries collected over 6 months. Reflecting on the prior 24 hours, patients will recall on an ordinal (0-9) scale maximum pain, distress, and disability, judge whether they were in a """"""""crisis,"""""""" and note pain locations andtheir various types of utilization. Daily pain intensity ratings will be transformed into pain episode counts using a formulaic threshold for a painful episode. The formula calculates each patient's threshold individually, based on his/her pain ratings. The models will measure the effect of several classes of explanatory variables (demographic, disease-related, psycho social, and readiness to utilize care), operationalized using primary data and validated instruments. Patients will be recruited from the central and Tidewater regions of Virginia, will undergo an initial survey battery, chart review, and a brief final survey, venipuncture and urine sampling, and complete pain diaries daily for 6 months. This study will advance knowledge of the etiology and influences on pain and pain response in sickle cell disease. By revealing potentially mutable explanatory variables, the study's results will suggest targets of biobehavioral treatment interventions. The study will also advance methods of measuring pain and pain response in sickle cell disease. By measuring pain directly, simultaneously with utilization, our results may validate or invalidate prior studies. Results of this study can be used to improve sickle cell pain diagnosis and treatment and to dispel myths about sickle cell pain.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL064122-02
Application #
6527290
Study Section
Special Emphasis Panel (ZRG1-RPHB-2 (04))
Program Officer
Bonds, Duane
Project Start
2001-09-11
Project End
2004-08-31
Budget Start
2002-09-01
Budget End
2003-08-31
Support Year
2
Fiscal Year
2002
Total Cost
$683,639
Indirect Cost
Name
Virginia Commonwealth University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Richmond
State
VA
Country
United States
Zip Code
23298
Smith, Wally R; McClish, Donna K; Dahman, Bassam A et al. (2015) Daily home opioid use in adults with sickle cell disease: The PiSCES project. J Opioid Manag 11:243-53
Ameringer, Suzanne; Elswick Jr, R K; Smith, Wally (2014) Fatigue in adolescents and young adults with sickle cell disease: biological and behavioral correlates and health-related quality of life. J Pediatr Oncol Nurs 31:6-17
Alsalman, Abdulkhaliq J; Smith, Wally R (2013) Expanding the framework of assessing adherence and medication-taking behavior. J Pain Palliat Care Pharmacother 27:114-24
Smith, Wally R (2011) Pain in sickle cell disease: the future of acute treatment. Expert Rev Hematol 4:237-9
Smith, Wally R; Ballas, Samir K; McCarthy, William F et al. (2011) The association between hydroxyurea treatment and pain intensity, analgesic use, and utilization in ambulatory sickle cell anemia patients. Pain Med 12:697-705
McClish, Donna K; Smith, Wally R; Dahman, Bassam A et al. (2009) Pain site frequency and location in sickle cell disease: the PiSCES project. Pain 145:246-51
Aisiku, Imoigele P; Smith, Wally R; McClish, Donna K et al. (2009) Comparisons of high versus low emergency department utilizers in sickle cell disease. Ann Emerg Med 53:587-93
Levenson, James L; McClish, Donna K; Dahman, Bassam A et al. (2008) Depression and anxiety in adults with sickle cell disease: the PiSCES project. Psychosom Med 70:192-6
Smith, Wally R; Penberthy, Lynne T; Bovbjerg, Viktor E et al. (2008) Daily assessment of pain in adults with sickle cell disease. Ann Intern Med 148:94-101
Aisiku, Imoigele P; Penberthy, Lynne T; Smith, Wally R et al. (2007) Patient satisfaction in specialized versus nonspecialized adult sickle cell care centers: the PiSCES study. J Natl Med Assoc 99:886-90

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