Chronic opioid therapy (COT) for chronic non-cancer pain is frequently debated, and its effectiveness is unproven in sickle cell disease (SCD). The authors conducted a descriptive study among 83 adult SCD patients and compared severity of disease and pain symptoms among those who were prescribed COT (n=29) with those who were not using COT. All patients completed baseline laboratory pain assessment and questionnaires between January 2010 and June 2014. Thereafter, participants recorded daily pain, crises, function, and healthcare utilization for 90 days using electronic diaries. Analyses were conducted shortly after the final diary data collection period. Patients on COT did not differ on age, sex, or measures of disease severity. However, patients on COT exhibited greater levels of clinical pain (particularly non-crisis), central sensitization, depression, and increased diary measures of pain severity, function, and healthcare utilization on crisis and non-crisis diary days, as well as a greater proportion of days in crisis. Including depressive symptoms in multivariate models did not change the associations between COT and pain, interference, central sensitization, or utilization. Additionally, participants not on COT displayed the expected positive relationship between central sensitization and clinical pain, whereas those on COT demonstrated no such relationship, despite having both higher central sensitization and higher clinical pain. Overall, the results point out a high symptom burden in SCD patients on COT, including those on high-dose COT, and suggest that nociceptive processing in SCD patients on COT differs from those who are not.

Objective:People living with sickle cell disease (SCD) experience severe episodic and chronic pain and frequently report poor interpersonal treatment within health-care settings. In this particularly relevant context, we examined the relationship between perceived discrimination and both clinical and laboratory pain.Methods:Seventy-one individuals with SCD provided self-reports of experiences with discrimination in health-care settings and clinical pain severity, and completed a psychophysical pain testing battery in the laboratory.Results:Discrimination in health-care settings was correlated with greater clinical pain severity and enhanced sensitivity to multiple laboratory-induced pain measures, as well as stress, depression, and sleep. After controlling for relevant covariates, discrimination remained a significant predictor of mechanical temporal summation (a marker of central pain facilitation), but not clinical pain severity or suprathreshold heat pain response. Furthermore, a significant interaction between experience with discrimination and clinical pain severity was associated with mechanical temporal summation; increased experience with discrimination was associated with an increased correlation between clinical pain severity and temporal summation of pain.Discussion:Perceived discrimination within health-care settings was associated with pain facilitation. These findings suggest that discrimination may be related to increased central sensitization among SCD patients, and more broadly that health-care social environments may interact with pain pathophysiology.

Hierarchical logistic regression analyses revealed that those with greater income (OR = 0.79, p = .043), and greater pain interference (OR = 0.79, p = .042), were less likely to have non-treatment of pain. Given that people with dementia often report less pain interference, we examined if other factors, such as depression, influenced the relationship between pain interference and pain non-treatment. A significant interaction between pain-interference and depression predicted the non-treatment of pain, indicating that those with less pain interference were more likely to have non-treatment of pain (OR = 1.04, p = .040), but only if they had lower levels of depression. Pain may get less attention among these individuals because distress is less visible. When older adults with dementia present with lower levels of distress, care partners and medical providers may miss pain-related concerns. To improve pain recognition and treatment, additional training on how to identify pain and distress through behavioral observations is needed. Early identification may reduce the daily burden of pain, decrease the likelihood of more serious healthcare problems, and limit hospital admissions for this population. Support: NIH/NINR Grant R01-NR014657-01A1), MIRECC, VA HSRD IQUEST. (165) Sleep disturbance mediates the association between social discrimination and pain severity in knee osteoarthritis