Changes in intensity, location, and quality of vaso-occlusive pain in children with sickle cell disease

Jacob, Eufemia; Miaskowski, Christine; Savedra, Marilyn; Beyer, Judith; Treadwell, Marsha; Styles, Lori

doi:10.1016/s0304-3959(02)00374-3

Cited by 52 publications

(66 citation statements)

References 16 publications

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“…Comparing the pain score upon discharge to that on readmission within 1 week (Table VII) suggests that a major reason for such readmission is premature discharge from the hospital in the previous admission. Jacob et al [24] recently described a similar blunted decrease in pain intensity in hospitalized children with acute sickle cell painful episodes. The second reason for readmission in our patients is withdrawal syndrome that precipitates a new acute painful episode.…”

Section: Discussionmentioning

confidence: 79%

Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology, and prognostic significance

2005

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The acute sickle cell painful episode is the most common cause of hospitalization of patients with sickle cell anemia. Its detailed clinical features and peri-discharge features are not well known. In order to determine the actual pattern of hospital admissions of patients with SS and the causes of frequent hospital readmissions and their prognostic significance, we conducted a prospective longitudinal and observation cohort study of all adult patients with sickle cell anemia admitted to Thomas Jefferson University Hospital between January 1998 and December 2002. Major outcome measures included the frequency, etiology, and prognostic significance of readmissions to the hospital within 1 week and 1 month after discharge. Incidence of mortality among patients during the study period was also determined. Analysis of the data showed that about 50% of hospital admissions for acute painful episodes were readmitted within 1 month after discharge, and about 16% of all admissions were within 1 week after discharge. The intensity of pain score decreased significantly during the first 4 days of hospital admission (P < 0.001) and then reached a plateau until discharge. The mean score of pain intensity was >7 throughout the hospital stay. Causes of hospital readmission included premature discharge, withdrawal syndrome, and recurrence of new acute episodes. Readmission within 1 week after discharge was associated with higher mortality than otherwise. This study shows that hospital readmission of adult patients with sickle cell anemia is common. It suggests that improvement is needed in the management of pain during hospitalization and at home after discharge. Patients who are readmitted frequently within 1 week of discharge have poor prognosis and require careful monitoring.

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Section: Discussionmentioning

confidence: 79%

Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology, and prognostic significance

2005

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“…Pain intensity was assessed and recorded four times a day with a verbal response pain scale on an 11-point scale. To account for variances in verbal response pain scales during vaso-occlusive crisis also, the worst and least daily painscores were analyzed [32]. Because the experience of pain may vary from person to person in perception, response, and reported intensity, individual change in pain intensity, importance of pain control, and perceived pain control were assessed separately from the other measurements between the day of admission and 2 days later [33].…”

Section: Outcomementioning

confidence: 99%

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

et al. 2007

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Intravenous morphine is the treatment of choice for severe pain during vaso‐ occlusive crisis in sickle cell disease (SCD). However, side effects of morphine may hamper effective treatment, and high plasma levels of morphine are associated with severe complications such as acute chest syndrome. Furthermore, adequate dosing remains a problem since no objective measurement of pain severity exists and analgesia should be titrated upon the patient's reported pain. Patient‐controlled analgesia (PCA) may therefore be an interesting alternative since patients can titrate the level of analgesia themselves. In this randomized controlled study, the efficacy of intravenous morphine administration with PCA was compared with continuous infusion (CI) of morphine in patients with SCD during vaso‐occlusive crisis. Twenty five consecutive episodes of vaso‐occlusive crisis in 19 patients with SCD were included in the study. Patients in the PCA‐group had a markedly and significant lower mean and cumulative morphine consumption when compared with the patients in the CI‐group (0.5 mg/hr versus 2.4 mg/hr (P < 0.001) and 33 mg versus 260 mg (P = 0.018, respectively). The mean daily pain scores were comparable (4.9 versus 5.3). The lower mean and cumulative morphine consumption in the PCA‐group led to significant less nausea and constipation during treatment when compared with the CI‐group (area under the curve, respectively, 11 versus 18 (P = 0.045) and 30 versus 45 (P = 0.021). Furthermore, a nonsignificant reduction in the duration of hospital admission of 3 days was observed in the PCA‐group. PCA results in adequate pain relief at a much lower morphine consumption and should considered to be the first choice in morphine administration to sickle cell patients admitted with vaso‐occlusive crisis. Am. J. Hematol., 2007. © 2007 Wiley‐Liss, Inc.

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“…The increased number of painful sites noted during low-dose ketamine admissions could also reflect progression towards a chronic pain phenotype. The mean age of our patients was older than previously described cohorts of patients with SCD, which could suggest that older patients are more likely to exhibit evidence of a chronic pain phenotype and poor responsiveness to opioids leading physicians to seek additional therapies such as low-dose ketamine [31][32][33]. Our study population experienced much higher utilization of physical therapy services, whirlpool, and heat packs than previously reported [33].…”

Section: Discussionmentioning

confidence: 67%

Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain: A Single Center Experience

Neri¹,

Pestieau

Young³

et al. 2014

J Anesth Clin Res

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Background: Opioids are the mainstay of therapy for painful vasoocclusive episodes (VOEs) in sickle cell disease (SCD). Based on limited studies, low-dose ketamine could be a useful adjuvant analgesic for refractory SCD pain, but its safety and efficacy has not been evaluated in pediatric SCD. Procedure:Using retrospective chart review we recorded and compared characteristics of hospitalizations of 33 children with SCD hospitalized with VOE who were treated with low-dose ketamine and opioid PCA vs. a paired hospitalization where the same patients received opioid PCA without ketamine. We seek to 1) describe a single center experience using adjuvant low-dose ketamine with opioid PCA for sickle cell related pain, 2) retrospectively explore the safety and efficacy of adjuvant low-dose ketamine for pain management, and 3) determine ketamine's effect on opioid consumption in children and adolescents hospitalized with VOE. Results:During hospitalizations where patients received ketamine, pain scores and opioid use were higher (6.48 vs. 5.99; p=0.002 and 0.040 mg/kg/h vs. 0.032 mg/kg/h; p=0.004 respectively) compared to hospitalizations without ketamine. In 3 patients, ketamine was discontinued due to temporary and reversible psychotomimetic effects. There were no additional short term side effects of ketamine.Conclusions: Low-dose ketamine has an acceptable short-term safety profile for patients with SCD hospitalized for VOE. Lack of an opioid sparing effect of ketamine likely represents use of low-dose ketamine for patients presenting with more severe VOE pain. Prospective randomized studies of adjuvant low-dose ketamine for SCD pain are warranted to determine efficacy and long-term safety.

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Changes in intensity, location, and quality of vaso-occlusive pain in children with sickle cell disease

Cited by 52 publications

References 16 publications

Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology, and prognostic significance

Hospital readmission for adult acute sickle cell painful episodes: frequency, etiology, and prognostic significance

Patient‐controlled analgesia versus continuous infusion of morphine during vaso‐occlusive crisis in sickle cell disease, a randomized controlled trial

Low-dose Ketamine for Children and Adolescents with Acute Sickle Cell Disease Related Pain: A Single Center Experience

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