Sickle cell disease (SCD) is an inherited disease characterized by chronic hemolytic anemia with acute and chronic complications. The painful episode that results from tissue ischemia due to vaso-occlusion is the most common reason for admission in children with SCD. Painful vaso-occlusive episodes (VOE) account for a significant number of emergency department and hospital admissions. Morphine via patient controlled analgesia is widely used in hospital settings to manage severe pain in SCD. However, the opioid dose required to achieve pain relief varies considerably within each painful episode, from one episode to another, and between individual patients, and some patients do not receive adequate relief. Our hypothesis is that children with sickle cell disease do not achieve plasma concentrations of morphine at therapeutic levels. We propose to examine whether the lack of response to morphine is related to subtherapeutic morphine concentrations or other factors. Pharmacokinetic parameters of morphine will be compared with known population values during acute painful states. One of the blood samples will be used for genotyping genes (UGT2B7, MOR1, COMT) that may affect response to morphine. Response to morphine will be assessed using pain intensity and pain relief scores, pain location and pain quality, and side effects such as sedation/drowsiness, nausea, itching, hypoventilation (oxygen saturation, respiratory rate), or hypotension (blood pressure). Data from this career development award K23 will be used to design optimal pain management strategies and clinical protocols that aim to minimize the short and long term consequences resulting from untreated or inadequately managed pain during acute vaso-occlusive episodes in children with sickle cell disease. These advancements in pain management will lead Dr. Jacob to her long term career goal as an independent clinical researcher.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NR009192-03
Application #
7238003
Study Section
National Institute of Nursing Research Initial Review Group (NRRC)
Program Officer
Mann Koepke, Kathy M
Project Start
2005-08-15
Project End
2007-08-10
Budget Start
2007-06-07
Budget End
2007-08-10
Support Year
3
Fiscal Year
2007
Total Cost
$11,272
Indirect Cost
Name
Baylor College of Medicine
Department
Pediatrics
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Jacob, Eufemia; Sockrider, Marianna M; Dinu, Marlen et al. (2010) Respiratory symptoms and acute painful episodes in sickle cell disease. J Pediatr Oncol Nurs 27:33-9
Granados, Renee; Jacob, Eufemia (2009) Pain experience in hospitalized adults with sickle cell disease. Medsurg Nurs 18:161-7, 182; quiz 168
Jacob, Eufemia; Hockenberry, Marilyn; Mueller, Brigitta U et al. (2008) Analgesic Response to Morphine in Children with Sickle Cell Disease: A Pilot Study. J Pain Manag 2:179-190
Jacob, Eufemia; Scorsone, Kathy; Blaney, Susan M et al. (2008) Synergy of karenitecin and mafosfamide in pediatric leukemia, medulloblastoma, and neuroblastoma cell lines. Pediatr Blood Cancer 50:757-60
Jacob, Eufemia; Mueller, Brigitta U (2008) Pain experience of children with sickle cell disease who had prolonged hospitalizations for acute painful episodes. Pain Med 9:13-21
Jacob, Eufemia; Hockenberry, Marilyn; Mueller, Brigitta U (2008) Effects of Patient Controlled Analgesia Hydromorphone during Acute Painful Episodes in Adolescents with Sickle Cell Disease: A Pilot Study. J Pain Manag 1:173-178
Jacob, Eufemia; Miaskowski, Christine; Savedra, Marilyn et al. (2007) Quantification of analgesic use in children with sickle cell disease. Clin J Pain 23:8-14
Jacob, Eufemia; Hesselgrave, Joy; Sambuco, Gennaro et al. (2007) Variations in pain, sleep, and activity during hospitalization in children with cancer. J Pediatr Oncol Nurs 24:208-19