Sickle cell-related pain: Perceptions of medical practitioners

Shapiro, Bennett M.; Benjamin, Lennette J.; Payne, Richard; Heidrich, George

doi:10.1016/s0885-3924(97)00019-5

Cited by 188 publications

(130 citation statements)

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“…[10][11][12][13] It is a common perception of emergency physicians and staff that SCD patients presenting to the ED are opioid dependent, and this belief may lead to inconsistent or inadequate treatment. 14,15 Both physicians and nurses tend to overestimate the prevalence of addiction in the SCD population, which has been documented to range from 0% to 11%. 12,15 Further exploration is required to fully understand the frequent use of the ED, which may represent a higher acuity of illness, lack of access to a sickle cell provider, or other complex psychosocial issues.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 Both physicians and nurses tend to overestimate the prevalence of addiction in the SCD population, which has been documented to range from 0% to 11%. 12,15 Further exploration is required to fully understand the frequent use of the ED, which may represent a higher acuity of illness, lack of access to a sickle cell provider, or other complex psychosocial issues.…”

Section: Discussionmentioning

confidence: 99%

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Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Tanabe

Artz

Courtney

et al. 2010

Academic Emergency Medicine

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Objectives: The objectives were to report the baseline (prior to quality improvement interventions) patient and visit characteristics and analgesic management practices for each site participating in an emergency department (ED) sickle cell learning collaborative.Methods: A prospective, multisite longitudinal cohort study in the context of a learning-collaborative model was performed in three midwestern EDs. Each site formed a multidisciplinary team charged with improving analgesic management for patients with sickle cell disease (SCD). Each team developed a nurse-initiated analgesic protocol for SCD patients (implemented after a baseline data collection period of 3.5 months at one site and 10 months at the other two sites). All sites prospectively enrolled adults with an acute pain crisis and SCD. All medical records for patients meeting study criteria were reviewed. Demographic, health services, and analgesic management data were abstracted, including ED visit frequency data, ED disposition, arrival and discharge pain score, and name and route of initial analgesic administered. Ten interviews per quarter per site were conducted with patients within 14 days of their ED discharge, and subjects were queried about the highest level of pain acceptable at discharge. The primary outcome variable was the time to initial analgesic administration. Variable data were described as means and standard deviations (SDs) or medians and interquartile ranges (IQR) for nonnormal data.Results: A total of 155 patients met study criteria (median age = 32 years, IQR = 24-40 years) with a total of 701 ED visits. Eighty-six interviews were conducted. Most patients (71.6%) had between one and three visits to the ED during the study period. However, after removing Site 3 from the analysis because of the short data enrollment period (3.5 months), which influenced the mean number of visits for the entire cohort, 52% of patients had between one and three ED visits over 10 months, 21% had four to nine visits, and 27% had between 10 and 67 visits. Fifty-nine percent of patients were discharged home. The median time to initial analgesic for the cohort was 74 minutes . Differences between choice of analgesic agent and route selected were evident between sites. For the cohort, 680 initial analgesic doses were given (morphine sulfate, 42%; hydromorphone, 46%; meperidine, 4%; morphine sulfate and ibuprofen or ketorolac, 7%) using the following routes: oral (2%), intravenous (67%), subcutaneous (3%), and intramuscular (28%). Patients reported a significantly lower targeted discharge pain score (mean ± SD = 4.19 ± 1.18) compared to the actual documented discharge pain score within 45 minutes of discharge (mean ± SD = 5.77 ± 2.45; mean difference = 1.58, 95% confidence interval = .723 to 2.44, n = 43).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Tanabe

Artz

Courtney

et al. 2010

Academic Emergency Medicine

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“…However, adequate pain control has been problematic for several reasons, including tolerance, dependence, sedation, respiratory depression, nausea, constipation, and pruritus. Furthermore, because of the fear among many health professionals that patients will become addicted, many sickle cell patients in pain management are under-treated with opioids (1,7,8).…”

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confidence: 99%

Naloxone acts as a potent analgesic in transgenic mouse models of sickle cell anemia

Lunzer

Yekkirala

Hebbel

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

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“…Previous work has shown that adults with SCD are met with high levels of mistrust, with health professionals believing that they exaggerate their pain and exhibit significant drug seeking behavior [13,14]. Based on parental desire to have more input into the care of their child, it is reasonable to assume that the lack of objective findings in children with SCD makes it more difficult for hospital staff to fully interpret the disease severity.…”

Section: Discussionmentioning

confidence: 99%

Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

Brousseau

Mukonje

Brandow

et al. 2009

Pediatric Blood & Cancer

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BackgroundA previous study reported increased dissatisfaction with hospital care for children with sickle cell disease (SCD); however, its small size excluded determining whether race and chronic disease explained the difference.ProcedureAt hospital discharge, parents of children with SCD completed a survey assessing satisfaction with their child's hospital care. Results were compared to three years of satisfaction surveys for children with asthma or admitted to a general pediatrician's service collected as quality improvement for the hospital. The primary outcome was parent reported dissatisfaction with care. A chi‐square was used to compare dissatisfaction between SCD and each comparison group.ResultsParents of 639 children were included, 34 children with SCD, 124 with asthma, and 481 general pediatric patients. Parents of children with SCD were more often dissatisfied with their child's care compared to children with asthma (32.4% vs. 16.9%, P < 0.05) and general pediatric patients (32.4% vs. 14.6%, P < 0.05). Among all children, dissatisfaction was higher in families with minority children (21.1% vs. 12.6%); this difference did not exist among children with asthma. Among African‐American children, a higher proportion of parents of children with SCD believed their child was treated differently because of race than children with asthma (45.5% vs. 2.8%, P < 0.01) or general pediatric patients (45.5% vs. 8.3%, P < 0.01).ConclusionParents of children with SCD report increased dissatisfaction with care. While dissatisfaction was higher in minority families, the high rate of parental concern about race as a reason for families of children with SCD is not seen in African‐American families of children with asthma. Pediatr Blood Cancer 2009;53:174–178. © 2009 Wiley‐Liss, Inc.

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Sickle cell-related pain: Perceptions of medical practitioners

Cited by 188 publications

References 9 publications

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Adult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic Management

Naloxone acts as a potent analgesic in transgenic mouse models of sickle cell anemia

Dissatisfaction with hospital care for children with sickle cell disease not due only to race and chronic disease

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