Several Factors Linked to Acute Pain Trajectories in Adolescents With Sickle Cell

Pain Reports published a study that investigated potential variations in acute pain trajectories based on sex and frequency of pain episodes among adolescents diagnosed with sickle cell disease (SCD) who sought care at the emergency department (ED).

“Pain is the most common complication of sickle cell disease and is associated with significant morbidity, poor health-related quality of life, and premature mortality,” the authors wrote. However, “the period around adolescence is associated with sex differences in pain in other painful conditions, but sex differences in acute pain during adolescence are not well described in SCD.”

Researchers utilized a retrospective approach, drawing upon electronic health records from a comprehensive pediatric SCD program that spanned multiple campuses. Pain intensity scores, pain management strategies, and hospitalization rates were analyzed as primary outcomes.

The study included 113 adolescents. Their average age was 16.6 years, and 41.6% were female. The majority (77.9%) had severe genotypes (such as HbSS), and 43.4% had a history of at least 3 instances of high health care utilization (HCU) for pain, which served as a marker of pain episode frequency. Patients with a history of high HCU for pain demonstrated higher mean pain intensity scores upon presentation to the ED. These individuals were more likely to receive intravenous or intranasal opioids and were also more frequently hospitalized compared with their counterparts with lower pain episode frequency.

Additionally, the researchers explored the associations between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score. After adjusting for factors such as opioid dosage per kilogram of body weight and hydroxyurea prescription, the results showed that adolescent females with a history of high HCU for pain exhibited a slower decline in pain intensity during treatment in the ED.

The authors acknowledged their study had several limitations. Despite being conducted across multiple campuses within a single institution, the study’s findings may pertain primarily to institutional practices, thus limiting its generalizability. Additionally, the investigators excluded ED visits in which patients had already received analgesics from emergency medical services or had been treated at an external hospital prior to arriving at the ED, an approach that may have resulted in unintentionally overlooked severe pain episodes and disproportionately affected individuals seeking initial care at other, more distant facilities.

While the study does provide novel insights into acute pain and acute pain trajectories in adolescents with SCD, further research is needed on the topic.