Impact of early analgesia on hospitalization outcomes for sickle cell pain crisis

Payne, Jason; Aban, Inmaculada; Hilliard, Lee; Madison, Jennifer; Bemrich-Stolz, Christina J.; Howard, Thomas H.; Brandow, Amanda M.; Waite, Emily; Lebensburger, Jeffrey D.

doi:10.1002/pbc.27420

Cited by 15 publications

(10 citation statements)

References 23 publications

(47 reference statements)

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“…This may be accomplished with the use of β-blocker such as propranolol [ 70 ], or more appropriately, with aggressive analgesia treatment. Early achievement of maximum analgesia improved hospitalization outcomes [ 71 ].…”

Section: Introductionmentioning

confidence: 99%

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

et al. 2021

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Painful vaso-occlusive crisis (VOC) remains the most common reason for presenting to the Emergency Department and hospitalization in patients with sickle cell disease (SCD). Although two new agents have been approved by the Food and Drug Administration for treating SCD, they both target to reduce the frequency of VOC. Results from studies investigating various approaches to treat and shorten VOC have so far been generally disappointing. In this paper, we will summarize the complex pathophysiology and downstream events of VOC and discuss the likely reasons for the disappointing results using monotherapy. We will put forward the rationale for exploring some of the currently available agents to either protect erythrocytes un-involved in the hemoglobin polymerization process from sickling induced by the secondary events, or a multipronged combination approach that targets the complex downstream pathways of VOC.

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Section: Introductionmentioning

confidence: 99%

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

et al. 2021

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“…To date, there has been a paucity of research in SCD focused on pain prediction, despite the critical need. The ability to objectively and accurately predict pain severity and onset could result in more prompt and effective treatment of pain crises, leading to improved outcomes, as well as encouraging more diligent use of medications [23,24]. Using our past experience, our hypothesis for this study was as follows: For SCD patients presenting in acute pain, can we feasibly obtain objective data from a wearable device and then utilize machine learning techniques to accurately predict pain scores?…”

Section: Introductionmentioning

confidence: 99%

Use of Mobile Health Apps and Wearable Technology to Assess Changes and Predict Pain During Treatment of Acute Pain in Sickle Cell Disease: Feasibility Study

Johnson¹,

Yang²,

Gollarahalli³

et al. 2019

JMIR Mhealth Uhealth

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BackgroundSickle cell disease (SCD) is an inherited red blood cell disorder affecting millions worldwide, and it results in many potential medical complications throughout the life course. The hallmark of SCD is pain. Many patients experience daily chronic pain as well as intermittent, unpredictable acute vaso-occlusive painful episodes called pain crises. These pain crises often require acute medical care through the day hospital or emergency department. Following presentation, a number of these patients are subsequently admitted with continued efforts of treatment focused on palliative pain control and hydration for management. Mitigating pain crises is challenging for both the patients and their providers, given the perceived unpredictability and subjective nature of pain.ObjectiveThe objective of this study was to show the feasibility of using objective, physiologic measurements obtained from a wearable device during an acute pain crisis to predict patient-reported pain scores (in an app and to nursing staff) using machine learning techniques.MethodsFor this feasibility study, we enrolled 27 adult patients presenting to the day hospital with acute pain. At the beginning of pain treatment, each participant was given a wearable device (Microsoft Band 2) that collected physiologic measurements. Pain scores from our mobile app, Technology Resources to Understand Pain Assessment in Patients with Pain, and those obtained by nursing staff were both used with wearable signals to complete time stamp matching and feature extraction and selection. Following this, we constructed regression and classification machine learning algorithms to build between-subject pain prediction models.ResultsPatients were monitored for an average of 3.79 (SD 2.23) hours, with an average of 5826 (SD 2667) objective data values per patient. As expected, we found that pain scores and heart rate decreased for most patients during the course of their stay. Using the wearable sensor data and pain scores, we were able to create a regression model to predict subjective pain scores with a root mean square error of 1.430 and correlation between observations and predictions of 0.706. Furthermore, we verified the hypothesis that the regression model outperformed the classification model by comparing the performances of the support vector machines (SVM) and the SVM for regression.ConclusionsThe Microsoft Band 2 allowed easy collection of objective, physiologic markers during an acute pain crisis in adults with SCD. Features can be extracted from these data signals and matched with pain scores. Machine learning models can then use these features to feasibly predict patient pain scores.

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“…Both earlier and higher opioid doses in the emergency department were shown to be associated with shorter hospital stays ( 26 ). Still, the pain of many patients is refractory to standard abortive therapy.…”

Section: Discussionmentioning

confidence: 99%

Lidocaine and Ketamine Infusions as Adjunctive Pain Management Therapy: A Retrospective Analysis of Clinical Outcomes in Hospitalized Patients Admitted for Pain Related to Sickle Cell Disease

Zavala

Knoebel²,

Anitescu³

2022

Front. Pain Res.

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ObjectiveIn this study, we aim to evaluate the efficacy of adjunctive lidocaine and ketamine infusions for opioid reduction in the treatment of sickle cell disease in patients with vaso-occlusive crisis (VOC).DesignWe retrospectively reviewed a cohort of 330 adult sickle-cell crisis hospital encounters with 68 patients admitted to our institution from July 2017 to August 2018.MethodsUpon institutional IRB approval, we obtained initial data from billing records and performed chart reviews to obtain pain scores and confirm total opioid consumption. If provided by the acute pain consultation service, the patients received either a lidocaine or a ketamine infusion of 0.5–2 mg/min or 2–3 mcg/kg, respectively, for a maximum of 24–48 h. We compared the change in opioid consumption before and after infusion therapy to patients that did not receive ketamine or lidocaine.ResultsCompared to patients that did not receive infusion therapy, ketamine and lidocaine accounted for respective relative decreases of 28 and 23% in average daily morphine consumption (p = 0.02). Patients that received either infusion were 3 to 4 times more likely to decrease their opioid consumption independent of treatment length or baseline opioid doses (p < 0.01). Ketamine and lidocaine therapies were not associated with change in pain scores. When a patient had multiple admissions, opioid reduction was strongly correlated with initiation of infusions in the later visits.ConclusionBoth ketamine and lidocaine infusion therapies are effective in reducing opioid consumption for patients with vaso-occlusive crisis. Lidocaine infusion is emerging as an agent for stabilizing opioid doses in VOC for patients with high daily MME.

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Impact of early analgesia on hospitalization outcomes for sickle cell pain crisis

Abstract: Early achievement of maximum analgesia improved hospitalization outcomes and warrant further investigation in prospective studies of individualized pain plans.

Cited by 15 publications

References 23 publications

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

Use of Mobile Health Apps and Wearable Technology to Assess Changes and Predict Pain During Treatment of Acute Pain in Sickle Cell Disease: Feasibility Study

Lidocaine and Ketamine Infusions as Adjunctive Pain Management Therapy: A Retrospective Analysis of Clinical Outcomes in Hospitalized Patients Admitted for Pain Related to Sickle Cell Disease

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