A set of diagnostic criteria for defining the types of acute pain observed in patients with sickle cell disease was formulated by a multi-institutional panel of experts and published in The Journal of Pain.

Experts from the U.S. Food and Drug Administration, the American Academy of Pain Medicine, and the American Pain Society collaborated for the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy (ACTTION-APS-AAPM) initiative. The taxonomy consists of core diagnostic criteria for prototypical acute pain episodes, in addition to common features, modulating factors, impact/functional consequences, and putative mechanisms.

The group’s criteria for sickle cell disease-related acute pain are as follows:

  • Acute pain is defined as pain lasting ≥2 hours, but no more than 10 days. The patient must also present with ≥1 qualifying physical sign of functional impairment (eg, focal pain/tenderness elicited by palpation of the reported pain region, focal pain elicited by movement, or decreased range of motion or weakness).
  • Common features of acute pain episodes to be considered include age of onset (from 6-9 months of age, with an increase in incidence with increasing age), location of pain (typically in long, flat bones), pain descriptors at presentation (usually nociceptive), and course of pain (ie, crescendo-decrescendo).
  • Modulating factors to consider include demographics, genetics, geography, weather/climate, obstetrics/gynecology, behaviors, comorbidities, psychosocial factors, and therapies.
  • Functional consequences and impacts to consider include physical (eg, low sleep quality, less activity, and poor nutrition), psychological (ie, cognition effects), and social (eg, school/work absence) impact.
  • Putative mechanisms to consider include vaso-occlusion (eg, hypoxia, tissue damage, and inflammation) and chronic pain, which has an impact on acute pain by means of peripheral and central sensitization mechanisms.

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The group noted certain limitations to the formulation of this taxonomy, including scarce literature examining the relationship between acute and chronic pain in sickle cell disease.

“In addition to the fact that patients with sickle cell disease continue to require care for acute pain, there are numerous promising therapies in development, all of which could fail in clinical trials if the wrong pain process was targeted, or the wrong study design used,” noted the authors.

Reference

Field JJ, Ballas SK, Campbell CM, et al. Translations, Innovations, Opportunities, and Networks–American Pain Society–American Academy of Pain Medicine Pain Taxonomy diagnostic criteria for acute sickle cell disease pain [published online December 19, 2018]. J Pain. doi: 10.1016/j.jpain.2018.12.003

This article originally appeared on Clinical Pain Advisor