Sexual violence may be a possible risk factor for chronic pain in individuals with sickle cell disease (SCD), according to a recent letter to the editor in the journal Blood Advances. The letter was written by Maya Chopra, MBBS, of Vanderbilt University in Nashville, Tennessee, and colleagues.
“Individuals with SCD and a history of interpersonal violence exposure were almost 5 times more likely to report chronic pain and >6 times more likely to report the use of opiate-based medications daily,” Dr Chopra and colleagues wrote in their report.
The authors described 2 cases involving individuals with SCD who had been victims of sexually violent trauma. In each case, a period of 1 or 2 years had lapsed before the SCD care team was aware of these traumatic incidents.
The first case involved an 18-year-old patient with hemoglobin SS. The SCD care team became aware of the patient’s experience of a sexually violent trauma 2 years after it occurred over the course of an interview about changes in health care utilization. This patient had a hospitalization history prior to the event and reportedly had received opioid prescriptions, amounting to 3125 morphine equivalents the year before the trauma.
By 1 year after the traumatic event, this patient had received 3520 morphine equivalents, and by 2 years, the patient had received 8130 morphine equivalents. These levels of morphine equivalents corresponded to relative increases of 12.6% in the first year after trauma and 160.1% in the second year. The patient was diagnosed with chronic pain and was also thought to have posttraumatic stress disorder.
The patient received monthly blood transfusions, oral methadone (5 mg/d), and counseling. Following 13 months of multimodal therapy, this patient expressed being without pain on most days and was considered to no longer have chronic pain syndrome. Opioid prescriptions also decreased to 3824 morphine equivalents during the period of multimodal therapy.
The second case described by Dr Chopra and colleagues involved an 18-year-old patient with hemoglobin SC. The care team learned of this patient’s experience of a sexually violent trauma a year after it happened during an interview with the patient about changes to health care utilization. In the year before the traumatic event, this patient had received opioid prescriptions totaling 2760 morphine equivalents, and in the first year after the event, the patient received 8970 morphine equivalents.
This patient also was given monthly blood transfusions, was started on 10 mg/d of methadone, and received counseling. The patient also was diagnosed with anxiety and depression and underwent cognitive behavioral therapy. In the second year after the traumatic event, the patient received 3105 morphine equivalents, which represented a 65.4% relative reduction from the year before. After 12 months of multimodal therapy, this patient no longer met criteria for chronic pain syndrome.
“In summary, we have presented evidence that sexual trauma is a risk factor for chronic pain syndrome in SCD and is preceded by an annual increase in morphine equivalents,” the authors wrote in their report.
Chopra M, Byrd J, Wuichet K, DeBaun MR. Sexual violence as a precipitator of chronic pain in young adults with sickle cell disease. Blood Adv. 2022;6(16):4831-4833. doi:10.1182/bloodadvances.2022007600