University of Connecticut Health, Farmington, USA.
J Interpers Violence. 2020 Feb;35(3-4):924-942. doi: 10.1177/0886260517691521. Epub 2017 Feb 13.
Almost half of sickle cell disease (SCD) patients develop chronic, debilitating physical pain with uncertain genesis for which they primarily receive opiate-based palliative treatment. Psychological trauma exposure, especially interpersonal victimization, has been linked to the perception of pain in several medical diseases, but has yet to be examined in SCD patients. This study examines self-reported chronicity of pain and use of prescribed opiates in 50 adult SCD patients with and without a history of interpersonal violence exposure. We conducted a retrospective chart review of 50 consecutive SCD patients seen for medical care in an adult subspecialty hematology clinic. Data collected included demographics, opiate use, pain chronicity, and measures of anxiety, depression, and interpersonal violence exposure. Sixty-eight percent of patients reported past interpersonal violence exposure. The mean number of types of interpersonal violence exposure, including physical, sexual, or emotional abuse, was 2.76 ( = 1.63). SCD patients with a history of interpersonal violence exposure were almost five times more likely to report chronic pain and more than six times more likely to report use of opiate-based medications on a daily basis compared with SCD patients with no history of violence exposure. Depression and anxiety symptoms were associated with violence exposure, but did not account for the relationship between violence exposure and chronic pain or prescribed opiate use. Screening and assessment of exposure to interpersonal violence may be useful in addition to screening for mental health problems in the management of chronic pain with adults diagnosed with SCD. Such screening may contribute to addressing health care disparities given the preponderance of SCD patients who are of African American ethnoracial background.
几乎有一半的镰状细胞病 (SCD) 患者会出现慢性、使人虚弱的身体疼痛，其病因不明，主要接受阿片类药物的姑息治疗。心理创伤暴露，尤其是人际暴力，与几种医学疾病的疼痛感知有关，但尚未在 SCD 患者中进行研究。本研究检查了 50 名成年 SCD 患者中有无人际暴力暴露史的慢性疼痛和使用处方阿片类药物的情况。我们对在成人血液病专科诊所接受医疗护理的 50 名连续 SCD 患者进行了回顾性图表审查。收集的数据包括人口统计学数据、阿片类药物使用、疼痛慢性程度以及焦虑、抑郁和人际暴力暴露的测量。68%的患者报告有过去的人际暴力暴露史。人际暴力暴露的类型包括身体、性或情感虐待，平均数量为 2.76（ = 1.63）。与没有暴力暴露史的 SCD 患者相比，有过人际暴力暴露史的 SCD 患者报告慢性疼痛的可能性几乎高出五倍，报告每天使用阿片类药物的可能性高出六倍以上。抑郁和焦虑症状与暴力暴露有关，但不能解释暴力暴露与慢性疼痛或处方阿片类药物使用之间的关系。除了筛查心理健康问题外，对人际暴力的暴露进行筛查和评估可能有助于管理成年 SCD 患者的慢性疼痛。鉴于大多数 SCD 患者具有非裔美国人的种族背景，这种筛查可能有助于解决医疗保健方面的差异。
