Key Components of Pain Management for Children and Adults with Sickle Cell Disease

Brandow, Amanda M.; DeBaun, Michael R.

doi:10.1016/j.hoc.2018.01.014

Cited by 49 publications

(45 citation statements)

References 61 publications

(67 reference statements)

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“…374 The biology of SCD pain is complex and varied; it likely arises from multiple mechanisms depending on whether an individual is suffering from acute or chronic pain. 375 Pulmonary, 376 orthopedic, 377 psychosocial, 378 and other comorbidities of SCD can also give rise to painful complications in adults and children.…”

Section: Sickle Cell Diseasementioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

100

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Background Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

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Section: Sickle Cell Diseasementioning

confidence: 99%

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Darnall¹,

Krishnamurthy²,

Tsuei³

et al. 2020

JMIR Form Res

100

View full text Add to dashboard Cite

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“…Las crisis agudas de dolor que son de duración variable y se presentan en diferentes sitios del cuerpo, son causadas por una vasooclusión a repetición dispensada gracias a los eritrocitos deformados, lo que resulta en una lesión por reperfusión (en el afán del organismo por restablecer el flujo hacia el sitio afectado por la isquemia); éstas pueden ser desencadenadas por diferentes estímulos como vientos fríos, baja humedad en el ambiente, deshidratación estrés, consumo de alcohol y en mujeres, la menstruación [28,29,30,31]. Por otro lado, el dolor crónico es de carácter larvado y constante pues es desarrollado a partir de la sensibilización paulatina del sistema nervioso [32]. Darbari et al demostraron mediante un estudio llevado a cabo en Escandinavia que los bajos niveles de hemoglobina fetal en adultos están asociados a la magnitud de sensibilización del sistema nervioso central [33].…”

Section: Presentación Clínicaunclassified

Anemia de Células Falciformes: Correlación Clínico-Patológica

Saavedra¹

2019

archmed

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La anemia de células falciformes es la alteración hematológica heredada más común a nivel mundial. Esta dada por la presencia de hemoglobinas anormales (HbS y sus diferentes genotipos) a raíz de una mutación en las cadenas de globina. La tríada clínica consiste en eventos vaso-oclusivos, anemia hemolítica crónica y asplenia funcional. Hoy en día se ha documentado toda clase de complicaciones asociadas a la enfermedad, entre las cuales se encuentran: accidentes cerebrovasculares, infarto agudo de miocardio, hipertensión pulmonar, tromboembolismos venosos, infecciones, necrosis de la papila renal, enfermedad renal crónica, ulceraciones en miembros inferiores, enfermedades del aparato hepatobiliar y necrosis ósea avascular. Es de vital importancia la realización de un correcto enfoque clínico y terapéutico de los pacientes con anemia de células falciformes de modo que sea posible la prevención y tratamiento oportuno de las complicaciones asociadas a esta condición.

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“…Frequent acute painful episodes and attendant restrictions on daily activities of life require the combination of judicious opioid administration along with socioemotional supports [5]. Such painful events may be acute or chronic, treated on an inpatient or outpatient basis, or managed with opioid or nonopioid medications [6].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have shown that up to 30% of adolescents with SCD will ultimately develop chronic pain [9]. The most effective pain management regimens are those that address biological and psychosocial antecedents and consequences of disease manifestations [5,7].…”

Section: Introductionmentioning

confidence: 99%

“…Opioids are addictive, particularly in the adolescent population, which encompasses many children with SCD [5,10]. Although concerns surrounding the opioid epidemic have risen, adjunctive psychosocial interventions, such as cognitive behavioral therapy (CBT), are increasingly considered alongside traditional pharmacologic treatments [11,12].…”

Section: Introductionmentioning

confidence: 99%

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The Role of Cognitive Behavioral Therapy in Opioid Use Reduction in Pediatric Sickle Cell Disease: Protocol for a Systematic Review

2019

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Background Sickle cell disease (SCD) is a genetic disorder of red blood cells that results in acute and chronic health problems, including painful syndromes. Opioid analgesia is the mainstay of moderate to severe pain management in SCD, although adjunctive psychosocial approaches such as cognitive behavioral therapy (CBT) are increasingly incorporated. CBT has been used in populations of various ages to address a wide range of issues, such as mood disorders and chronic pain. It is unclear if effective CBT reduces the use of opioids to manage pain in pediatric SCD. Objective The aim of this study is to evaluate the association between CBT and decreased opioid use in children with SCD. Methods In this systematic review protocol, we describe our approach to applying predetermined eligibility criteria to searches of PubMed (including Medline), Embase, Cochrane, Web of Science, and PsycINFO databases, as well as Google Scholar and grey literature. In particular, we will use keywords to search for English-language studies of individuals with SCD aged 21 years old and younger published before November 2018. Keywords will allow us to assess for the primary outcome—total use of opioid medications—and the secondary outcomes—pain intensity and emotional functioning—during pain management using a combined opioid and CBT approach, opioids alone, or CBT alone. The review team will use standardized abstraction forms to review articles at the title, abstract, and full-text levels. Finally, reviewers will assess the risk for bias, quality of evidence, and adequacy of data for quantitative versus qualitative synthesis. If meta-analysis is deemed inappropriate, a narrative review will be conducted. Results We will report a summary of findings across studies that meet eligibility criteria to compare the extent to which adjunctive CBT is associated with decreased opioid use among children with SCD. Conclusions This systematic review will present the current state of the evidence on CBT and opioid use in pediatric SCD, which may inform clinical practice and health policy to support optimized pain management. International Registered Report Identifier (IRRID) PRR1-10.2196/13211

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Key Components of Pain Management for Children and Adults with Sickle Cell Disease

Cited by 49 publications

References 61 publications

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

Anemia de Células Falciformes: Correlación Clínico-Patológica

The Role of Cognitive Behavioral Therapy in Opioid Use Reduction in Pediatric Sickle Cell Disease: Protocol for a Systematic Review

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