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Longitudinal analysis of vaso-occlusive pain in young children with sickle cell disease
Abstracts
S5
A06 Internet and Computer Databases
A08 Pain Epidemiology
(116) Treatment history, patient satisfaction, and expectations: preliminary observations from a comprehensive patient registry
(118) Longitudinal analysis of vaso-occlusive pain in young children with sickle cell disease
A Cahana, B Theodore, S Rapp, H Wilson, J Robinson, and D Turk; University of Washington, Seattle, WA The Center for Pain Relief implemented a comprehensive registry (MyPainProfile, MPP) that captures patient (1) demographics, (2) history of the painful disorder, (3) history of medication and modalities prescribed. Although 1-3 are commonly obtained, MPP also assesses (4) current pain severity, location, and characteristics, (5) emotional and physical functioning, (6) substance use/misuse, and (7) perspectives on current and future treatments. In this study we focus on treatments. A consecutive sample of 564 patients had a mean age of 47 years (SD =14.8), mean pain duration of 7.6 years (SD = 8.7), and an average pain rating of 5.5 (SD = 2.2). The most common medications prescribed at the time of referral were opiates (78%), NSAIDS (70%), anti-depressants (66%), and anti-convulsants (56%). Over 91% were taking over-the-counter medications. Eighty-two percent of those prescribed opiates reported they were helpful for their pain compared to 44% for anti-depressants, 41% for anti-convulsants, 26% for NSAIDS, and 28% for over-the-counter analgesics. Other prior treatments included physical modalities (79%), physical therapy and exercise (75%), psychological interventions (46%), surgery (41%), and injections (39%). For those who had received them, physical modalities (77%), psychological interventions (68%), and physical therapy and exercise (67%) were perceived as more helpful than surgery (60%), injections (46%), or medications other than opioids. Patients expressed greatest interest in pursuing physical modalities (50%), physical therapy and exercise (48%), and psychological interventions (46%). Fewer than 1/3 were interested in considering injections (33%) or surgical interventions (29%). The benefits from a registry permit characterization of patient referrals and include identification of prior and current treatments, perceived effectiveness of treatments received, and interest in future treatments. The information about treatments is particularly useful as it provides opportunities to address patients’ expectations, to discuss treatment options, to enhance treatment satisfaction, and potentially reduce the possibility of excessive healthcare utilization.
B Ely, D Brodecki, C Coleman, P O’Neal, L Aertker, K Kesler, and C Dampier; St. Christopher’s Hospital for Children, Philadelphia, PA Pain caused by erythrocyte vaso-occlusion is the hallmark complication of sickle cell disease (SCD). Several studies have characterized the pain experience in older children and adults with this disorder, but little information is available for affected infants and young children. We conducted a longitudinal study (data collection 1999-2008) of pain experienced by these young children with SCD as reported by parents/guardians. When sickle cell related pain events occurred, parents/guardians reported pain occurrence, location, associated symptoms and treatment they provided. These data were collected using either daily paper diaries, daily calendars, or an electronic daily pager system depending on family preference. We obtained data on 103 children (58% male) beginning at a median age of 7.3 months (range 1.5, 65.2 months). The total number of days children were assessed for pain was 113,338 days. The total number of days children had reported pain was 2,238 days (2.0%). This represented 744 distinct episodes of pain, which typically lasted for several days (3 6 2.96 days mean 6 std dev). Summary data for children of all SCD genotypes and the subset of children with SCD-SS disease identified include; age range, # observed, # with $ 1 pain episode(%), and subset of SCD-SS diagnosis(n,%) 0-12 mo. n=59, n=18 (30.5%), n=11 (40.7%) 12-24 mo. n=53, n=21 (39.6%), n=14 (58.3%) 24-36 mo. n=56, n=27 (48.2%), n=21 (72.4%) 36-48 mo. n=52, n=25 (48.1%), n=17 (63%) 48-60 mo. n=47, n=27 (57.4%), n=18 (72%) 60-72 mo. n=36, n=24(66.7%), n=15 (71.4%) 72-84 mo. n-24, n=12 (50%), n=8 (53.3%) 84-96 mo. n=16, n=10 (62.5%), n=8 (72.7%) This study provides the first longitudinal description of pain occurrence in the first 7 yrs. of life. Reported pain was more prevalent in the SCD-SS patients, and was more likely to increase in frequency with age. This abstract will also be presented as an Oral Paper Presentation on May 8. Refer to the daily Schedule-At-A-Glance for presentation time and location.
A07 Meta-Analysis and Systematic Reviews (117) A systematic review of the current pharmaceutical treatments for osteoarthritis R Police, T Foster, Y Zhao, M Blieden, N Haber, and M Russell; Abt Bio-Pharma Solutions, Inc., Lexington, MA Osteoarthritis (OA) affects approximately 27 million adults in the U.S. A substantial burden of illness prevails despite the wide range of therapies used to treat OA, and treatment satisfaction and adherence are suboptimal, raising the question of the current state of research into better therapeutic options. To evaluate current research activity, treatment patterns, and guidelines, we systematically reviewed MEDLINE-indexed and non-indexed English-language literature on pharmaceutical treatments for OA published in the past three years. Literature pertaining to treatment patterns and clinical guidelines was restricted to the U.S. In total, we identified 54 publications eligible for inclusion. Two recent guidelines (ICSI & MQIC) primarily address pharmaceutical therapy for pain relief; the MQIC guideline provides a treatment algorithm incorporating risk for cardiovascular disease and gastrointestinal bleeding. Both guidelines also recommend interdisciplinary treatment combining pharmacology with rehabilitation or behavioral therapy. U.S. treatment patterns are not well researched; available data suggest that three-quarters of patients supplement pharmaceutical therapy with nonconventional treatments, and approximately 40% use NSAIDs. Current pharmacologic research focuses on knee or hip OA. Research activity varies within each drug class, with 10 primary studies assessing efficacy of oral non-opioid analgesics, principally in within-class comparisons. A larger number of studies evaluate alternatives to these agents with potentially greater safety, including hyaluronic acid (HA) injections (7), topical analgesics (6), and diacerein, an experimental symptomatic slow-acting drug in osteoarthritis (SYSADOA) (4). Four primary studies assess opioids, and one each assesses corticosteroids and bisphosphonates. The bulk of current research focuses on topical analgesics, diacerein, and HA injections for pain relief without the side effects of opioids or oral analgesics. New approaches could be integrated into upcoming versions of treatment guidelines. Future research should focus on treatments that combine pharmaceutical and nonpharmacologic modalities, particularly therapies containing a rehabilitative or behavioral component.
(119) Pain and psychological symptom differences in African Americans and European Americans experiencing motor vehicle collision B Roane, A Soward, D Orrey, R Swor, I Liberzon, D Clauw, and S McLean; UNC-Chapel Hill, Chapel Hill, NC Each year, approximately 4 million people are evaluated in United States Emergency Departments (ED) after experiencing motor vehicle collision (MVC) and discharged to home. North American studies indicate that 10%-20% of these individuals develop persistent post-MVC neck pain. Evidence from a variety of pain conditions suggests that African Americans (AA) may have increased vulnerability to pain compared to European Americans (EA). However, rates of post-MVC neck pain in AAs and EAs have not previously been compared. In this investigation we assessed rates of acute and persistent post-MVC neck pain in EA vs. AA individuals presenting to the ED after MVC. ED assessment included an assessment of demographic characteristics, neck pain severity (0-10 NRS), and peritraumatic distress (Peritraumatic Distress Inventory). One month follow-up assessment included an evaluation of neck pain severity (0-10 NRS) and posttraumatic stress disorder symptoms (Impact of Event Scale-Revised). To date, 129 patients have been enrolled in this ongoing study (22 AA and 107 EA). In the ED, AAs had more intense neck pain than EAs (5.3(3.4) vs. 3.2(3.1), p = .011), and had greater peritraumatic distress (25.5 (9.9) vs. 19.9 (9.6), p = .022). One month after MVC, AAs had more PTSD symptoms than EAs (37.4 (18.5) vs. 18.8 (17.4), p <.0001), and a trend toward greater neck pain (3.0 (3.8) vs. 1.7 (2.8), p = .146). These preliminary data suggest that AA may experience increased rates of pain and psychological sequelae after MVC. Whether these differences are due to lower socioeconomic status, greater life stress, challenges associated with racism and discrimination, and/ or genetic differences is not known. Further studies are needed comparing pain and psychological symptom outcomes after MVC in EA vs. AA individuals. (Supported by Grant 5R01AR056328-02 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.)
S5
A06 Internet and Computer Databases
A08 Pain Epidemiology
(116) Treatment history, patient satisfaction, and expectations: preliminary observations from a comprehensive patient registry
(118) Longitudinal analysis of vaso-occlusive pain in young children with sickle cell disease
A Cahana, B Theodore, S Rapp, H Wilson, J Robinson, and D Turk; University of Washington, Seattle, WA The Center for Pain Relief implemented a comprehensive registry (MyPainProfile, MPP) that captures patient (1) demographics, (2) history of the painful disorder, (3) history of medication and modalities prescribed. Although 1-3 are commonly obtained, MPP also assesses (4) current pain severity, location, and characteristics, (5) emotional and physical functioning, (6) substance use/misuse, and (7) perspectives on current and future treatments. In this study we focus on treatments. A consecutive sample of 564 patients had a mean age of 47 years (SD =14.8), mean pain duration of 7.6 years (SD = 8.7), and an average pain rating of 5.5 (SD = 2.2). The most common medications prescribed at the time of referral were opiates (78%), NSAIDS (70%), anti-depressants (66%), and anti-convulsants (56%). Over 91% were taking over-the-counter medications. Eighty-two percent of those prescribed opiates reported they were helpful for their pain compared to 44% for anti-depressants, 41% for anti-convulsants, 26% for NSAIDS, and 28% for over-the-counter analgesics. Other prior treatments included physical modalities (79%), physical therapy and exercise (75%), psychological interventions (46%), surgery (41%), and injections (39%). For those who had received them, physical modalities (77%), psychological interventions (68%), and physical therapy and exercise (67%) were perceived as more helpful than surgery (60%), injections (46%), or medications other than opioids. Patients expressed greatest interest in pursuing physical modalities (50%), physical therapy and exercise (48%), and psychological interventions (46%). Fewer than 1/3 were interested in considering injections (33%) or surgical interventions (29%). The benefits from a registry permit characterization of patient referrals and include identification of prior and current treatments, perceived effectiveness of treatments received, and interest in future treatments. The information about treatments is particularly useful as it provides opportunities to address patients’ expectations, to discuss treatment options, to enhance treatment satisfaction, and potentially reduce the possibility of excessive healthcare utilization.
B Ely, D Brodecki, C Coleman, P O’Neal, L Aertker, K Kesler, and C Dampier; St. Christopher’s Hospital for Children, Philadelphia, PA Pain caused by erythrocyte vaso-occlusion is the hallmark complication of sickle cell disease (SCD). Several studies have characterized the pain experience in older children and adults with this disorder, but little information is available for affected infants and young children. We conducted a longitudinal study (data collection 1999-2008) of pain experienced by these young children with SCD as reported by parents/guardians. When sickle cell related pain events occurred, parents/guardians reported pain occurrence, location, associated symptoms and treatment they provided. These data were collected using either daily paper diaries, daily calendars, or an electronic daily pager system depending on family preference. We obtained data on 103 children (58% male) beginning at a median age of 7.3 months (range 1.5, 65.2 months). The total number of days children were assessed for pain was 113,338 days. The total number of days children had reported pain was 2,238 days (2.0%). This represented 744 distinct episodes of pain, which typically lasted for several days (3 6 2.96 days mean 6 std dev). Summary data for children of all SCD genotypes and the subset of children with SCD-SS disease identified include; age range, # observed, # with $ 1 pain episode(%), and subset of SCD-SS diagnosis(n,%) 0-12 mo. n=59, n=18 (30.5%), n=11 (40.7%) 12-24 mo. n=53, n=21 (39.6%), n=14 (58.3%) 24-36 mo. n=56, n=27 (48.2%), n=21 (72.4%) 36-48 mo. n=52, n=25 (48.1%), n=17 (63%) 48-60 mo. n=47, n=27 (57.4%), n=18 (72%) 60-72 mo. n=36, n=24(66.7%), n=15 (71.4%) 72-84 mo. n-24, n=12 (50%), n=8 (53.3%) 84-96 mo. n=16, n=10 (62.5%), n=8 (72.7%) This study provides the first longitudinal description of pain occurrence in the first 7 yrs. of life. Reported pain was more prevalent in the SCD-SS patients, and was more likely to increase in frequency with age. This abstract will also be presented as an Oral Paper Presentation on May 8. Refer to the daily Schedule-At-A-Glance for presentation time and location.
A07 Meta-Analysis and Systematic Reviews (117) A systematic review of the current pharmaceutical treatments for osteoarthritis R Police, T Foster, Y Zhao, M Blieden, N Haber, and M Russell; Abt Bio-Pharma Solutions, Inc., Lexington, MA Osteoarthritis (OA) affects approximately 27 million adults in the U.S. A substantial burden of illness prevails despite the wide range of therapies used to treat OA, and treatment satisfaction and adherence are suboptimal, raising the question of the current state of research into better therapeutic options. To evaluate current research activity, treatment patterns, and guidelines, we systematically reviewed MEDLINE-indexed and non-indexed English-language literature on pharmaceutical treatments for OA published in the past three years. Literature pertaining to treatment patterns and clinical guidelines was restricted to the U.S. In total, we identified 54 publications eligible for inclusion. Two recent guidelines (ICSI & MQIC) primarily address pharmaceutical therapy for pain relief; the MQIC guideline provides a treatment algorithm incorporating risk for cardiovascular disease and gastrointestinal bleeding. Both guidelines also recommend interdisciplinary treatment combining pharmacology with rehabilitation or behavioral therapy. U.S. treatment patterns are not well researched; available data suggest that three-quarters of patients supplement pharmaceutical therapy with nonconventional treatments, and approximately 40% use NSAIDs. Current pharmacologic research focuses on knee or hip OA. Research activity varies within each drug class, with 10 primary studies assessing efficacy of oral non-opioid analgesics, principally in within-class comparisons. A larger number of studies evaluate alternatives to these agents with potentially greater safety, including hyaluronic acid (HA) injections (7), topical analgesics (6), and diacerein, an experimental symptomatic slow-acting drug in osteoarthritis (SYSADOA) (4). Four primary studies assess opioids, and one each assesses corticosteroids and bisphosphonates. The bulk of current research focuses on topical analgesics, diacerein, and HA injections for pain relief without the side effects of opioids or oral analgesics. New approaches could be integrated into upcoming versions of treatment guidelines. Future research should focus on treatments that combine pharmaceutical and nonpharmacologic modalities, particularly therapies containing a rehabilitative or behavioral component.
(119) Pain and psychological symptom differences in African Americans and European Americans experiencing motor vehicle collision B Roane, A Soward, D Orrey, R Swor, I Liberzon, D Clauw, and S McLean; UNC-Chapel Hill, Chapel Hill, NC Each year, approximately 4 million people are evaluated in United States Emergency Departments (ED) after experiencing motor vehicle collision (MVC) and discharged to home. North American studies indicate that 10%-20% of these individuals develop persistent post-MVC neck pain. Evidence from a variety of pain conditions suggests that African Americans (AA) may have increased vulnerability to pain compared to European Americans (EA). However, rates of post-MVC neck pain in AAs and EAs have not previously been compared. In this investigation we assessed rates of acute and persistent post-MVC neck pain in EA vs. AA individuals presenting to the ED after MVC. ED assessment included an assessment of demographic characteristics, neck pain severity (0-10 NRS), and peritraumatic distress (Peritraumatic Distress Inventory). One month follow-up assessment included an evaluation of neck pain severity (0-10 NRS) and posttraumatic stress disorder symptoms (Impact of Event Scale-Revised). To date, 129 patients have been enrolled in this ongoing study (22 AA and 107 EA). In the ED, AAs had more intense neck pain than EAs (5.3(3.4) vs. 3.2(3.1), p = .011), and had greater peritraumatic distress (25.5 (9.9) vs. 19.9 (9.6), p = .022). One month after MVC, AAs had more PTSD symptoms than EAs (37.4 (18.5) vs. 18.8 (17.4), p <.0001), and a trend toward greater neck pain (3.0 (3.8) vs. 1.7 (2.8), p = .146). These preliminary data suggest that AA may experience increased rates of pain and psychological sequelae after MVC. Whether these differences are due to lower socioeconomic status, greater life stress, challenges associated with racism and discrimination, and/ or genetic differences is not known. Further studies are needed comparing pain and psychological symptom outcomes after MVC in EA vs. AA individuals. (Supported by Grant 5R01AR056328-02 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.)