Pediatric pain screening identifies youth at risk of chronic pain in sickle cell disease

Abstract

Background This study aimed to evaluate the preliminary validation and application of a pain screening tool to identify biopsychosocial risk factors for chronic pain in pediatric sickle cell disease (SCD) and classify youth with SCD into prognostic risk groups. Method Youth presenting to a pediatric SCD clinic completed the Pediatric Pain Screening Tool (PPST), a brief 9‐item self‐report questionnaire developed for rapid identification of risk in youth with pain complaints. Youth also completed a battery of standardized patient‐reported outcomes, including pain characteristics, pain burden, functional disability, pain interference, depressive symptoms, pain catastrophizing, and fear of pain. Healthcare utilization was extracted from medical chart review. Results Seventy‐three 8‐ to 18‐year‐olds (94% Black, 57% female) with SCD participated. The PPST demonstrated discriminant validity that ranged from fair to excellent (area under the curves (AUC) = 0.74–0.93, P values < 0.001) for identifying significant pain frequency, disability, pain interference, and psychosocial distress. Receiver operating characteristic curve analyses indicated that previously established cutoff scores were appropriate for the SCD sample. Participants were classified into low‐risk (28.8%), medium‐risk (38.4%), and high‐risk (32.9%) groups, with significant group differences across measures, F(18, 116) = 6.67, P < 0.001. The high‐risk group reported significantly higher pain intensity, pain frequency, pain burden, functional disability, pain interference, and depressive symptoms relative to both low‐risk and medium‐risk groups (P values < 0.005). Conclusions The high‐risk group demonstrated a pain and psychosocial profile consistent with chronic SCD pain. The PPST may be useful for efficiently identifying youth with chronic SCD pain or those at risk of poor outcomes.

Vaso-occlusive crisis pain intensity, frequency, and duration: which best correlates with health-related quality of life in adolescents and adults with sickle cell disease?

“…Hypotheses were motivated by the growing evidence that SCD pain in some patients becomes far more frequent and complex with age, transforming from primarily acute pain in the form of short-lived VOCs in childhood to multifactorial chronic pain or acute-on-chronic pain beginning in adolescence or adulthood. 18,20,22,46,47 We did not find in our sample that the relationship between VOC pain and HRQOL differed statistically by age. Although we did find that VOC pain intensity seemed to explain more variation in satisfaction with social roles for the older group than the younger 2 groups, this age difference was not statistically significant.…”

Pain screening in youth with sickle cell disease: A quality improvement study

“…The PPST is a nine‐item questionnaire developed for the rapid identification of risk among youth with pain and yields a total score (0–9) with physical and psychosocial subscales to classify patients as having low (PPST total score <3), medium (PPST total score ≥3, psychosocial score <2), or high risk (PPST total score ≥3, psychosocial score ≥2) for persistent symptoms and disability. A recent study showed that the PPST demonstrated discriminant validity that ranged from fair to excellent for identifying significant pain frequency, disability, pain interference, and psychosocial distress among youth with SCD 1 …”

“…Despite the prevalence of chronic pain in youth with SCD, few studies have implemented screening protocols to identify chronic pain and related psychosocial challenges within clinical practice 1 . Through (i) identifying youth with SCD who have chronic pain or who may be at risk of developing persistent symptoms and disability, and (ii) identifying appropriate IHM modalities, providers may be able to reduce the burden of chronic pain and prevent it from leading to further psychosocial complications 1 . Thus, the purpose of this study was to (i) determine the feasibility of routine pain screening; (ii) identify and describe various clinical pain presentations; and (iii) understand preferences/resources related to engaging in IHM modalities within a pediatric SCD clinic.…”

Feasibility and preliminary efficacy of the Balance Program to reduce pain‐related disability in pediatric sickle cell disease

“…The RCI was developed to ensure that changes in scores between two time points are due to treatment effects rather than measurement unreliability or unsystematic error by incorporating psychometric properties of the measure and is the recommended statistical approach in psychotherapy research 39–41 . In this analytic approach, a cutoff score (“RCI”) is calculated using published norms and alphas 42 for the PROMIS Pain Interference and Pain Behavior measures 43–45 . Individual/participant change scores are then calculated (T1 – T0) and compared against the cutoff score.…”