Patient sex and high healthcare utilization (HCU) for acute pain are associated with acute pain trajectories in adolescents with sickle cell disease (SCD) requiring emergency treatment, according to a study published in Pain Reports. The authors of the study sought to assess whether patient sex and HCU affected acute pain trajectories among adolescent patients with SCD presenting at the emergency department.
The research team conducted a retrospective study by accessing existing electronic health record data available at a large, multi-campus, academic pediatric SCD program in the United States.
The study’s inclusion criteria covered all adolescents with SCD between the ages of 15 and 18 who had an outpatient/inpatient visit at least once in the last 2 years and a subsequent emergency department visit for pain associated with SCD in 2019. The exclusion criteria encompassed patients with concurrent pain conditions that might give rise to pain exacerbations similar to acute SCD pain, as well as patients whose pain intensity score was 1 or less.
Demographic and clinical data were extracted from the database. If a patient had 3 or more visits in a year for pain prior to the index emergency department visit, they were considered to have high HCU. Medication data were likewise recorded, especially opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and adjunctive analgesics.
The research team also took note of the length of hospital stay between emergency department presentation and discharge, as well as differences in pain intensity score upon admission and discharge. Of particular interest to the research team was how patients were managed in the initial 360 minutes (6 hours) from the first pain score on record.
A total of 113 patients met the inclusion criteria; among them were 66 males (58.4%) and 47 females (41.6%). The majority of patients (n=88; 77.9%) had HbSS or similarly severe genotype; a high percentage of patients (n=73; 64.6%) were prescribed disease-modifying therapies for SCD.
Almost all the patients in this study were prescribed short-acting opioids and NSAIDs; however, patients with high HCU due to pain were more likely to receive meloxicam or celecoxib (P <.001). A total of 43% of patients had 3 or more visits per year for pain.
There was no difference in terms of mean initial pain intensity scores upon presentation or HCU in terms of patient sex. The mean time to prescription of opioid analgesia was a mere 36.2 minutes. Patients admitted for SCD pain had a mean length of stay of 235.8 minutes. Female patients had a longer length of stay (P =.052), as did patients with high HCU for pain (P =.020).
Using a model that took into account patient sex, HCU, and follow-up, females with low HCU had the steepest slope in pain score over follow-up (1-minute slope =-.021). This was followed by males with low HCU (1-minute slope =-.019), and males with high HCU (1-minute slope =-.013).
“This study represents a detailed examination of acute pain and acute pain trajectories in a large sample of adolescents with SCD who present to the ED, by sex and history of pain frequency as measured by HCU for pain,” the authors wrote in their report.
Claudia R. Morris is the Executive Director of Food as Medicine Therapeutics, LLC and is on the scientific advisory Board for Trility. She is the inventor or co-inventor of several UCSF-Benioff Children’s Hospital Oakland patents/patent-pending applications that include nutritional supplements for autism/apraxia (receiving royalties). She also is an inventor or co-inventor of several Emory University School of Medicine patent application for nutritional supplements for autism, and coronaviruses, and kidney disease and is a consultant for Roche and CSL Behring, and an editor for the sickle cell disease-fever reference for UpToDate. Please see the reference for additional disclosure information.
Astles R, Liu Z, Gillespie SE, et al. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep. 2023;8(5):e1084. doi:10.1097/PR9.0000000000001084