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Publications

Multicenter Study Journal Article Research Support, N.I.H., Extramural Ppublish 19 citations

PubMed: 37544393 DOI: 10.1016/j.jpain.2023.07.029

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.

J Pain 25(1):153-164

Authors: Martha O Kenney, Samuel Wilson, Nirmish Shah, Andrey Bortsov, Wally R Smith, Jane Little, Sophie Lanzkron, Julie Kanter, Susan Padrino, Amma Owusu-Ansah, Alice Cohen, Payal Desai, Deepa Manwani, Sana Saif Ur Rehman, Ward Hagar, Francis Keefe

Affiliations

  • Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University, Durham, North Carolina.
  • 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.
  • Departments of Pediatrics & Hematology, Duke University, Durham, North Carolina.
  • Center for Translational Pain Medicine, Duke University, Durham, North Carolina.
  • Division of General Internal Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
  • Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Division of Hematology and Oncology, University of Alabama, Birmingham, Alabama.
  • School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • Department of Pediatrics, Division of Pediatric Hematology Oncology, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio.
  • Division of Hematology and Oncology, Newark Beth Israel Medical Center, Newark, New Jersey.
  • Levin Cancer Institute, Atrium Health, Charlotte, North Carolina.
  • Department of Pediatrics, Albert Einstein College of Medicine and the Children's Hospital at Montefiore (CHAM), Bronx, New York.
  • Department of Medicine, Division of Hematology, Washington University School of Medicine, St. Louis, Missouri.
  • Department of Pediatrics, UCSF Benioff Children's Hospital, Oakland, California.
  • Pain Prevention and Treatment Research Program, Department of Psychiatry and Behavioral Science, Duke University, Durham, North Carolina.

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.

MeSH

Registries, Cells, Hemoglobins, Chronic Pain, Anemia, Sickle Cell, Pain, Child

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