Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA.
Ann Behav Med. 2020 Jan 1;54(1):61-66. doi: 10.1093/abm/kaz022.
Opioid analgesics are frequently used in the home setting to manage episodic pain in youth with sickle cell disease (SCD). Given the risk of adverse side effects, including constipation and sedation, understanding factors associated with at-home opioid use is important for maximizing pain relief while minimizing negative side effects.
The present study aimed to evaluate the relationship between individual psychological factors (pain catastrophizing and negative affect), caregiver psychological factors (catastrophizing about child's pain and caregiver negative affect), and home opioid use in youth with SCD.
Youth with SCD (n = 32) and a caregiver (n = 28) recruited during a routine outpatient hematology visit completed electronic 14 day diaries assessing pain, opioid use, and psychological factors.
Approximately 28% of youth (n = 9) reported pain ≥50% of diary days and a third of youth (n = 11, 34%) used opioid analgesics at least one of the diary days. The number of days opioid analgesics were used ranged from 0 to 7 (50% of diary days). Results from generalized linear mixed models indicated greater child negative affect accounted for increased odds of opioid use on a given day when accounting for pain intensity. Greater caregiver catastrophizing about children's pain was also associated with increased odds of children's opioid use.
Child and parent psychological factors relate to child opioid use at home for SCD-related pain. Future research is warranted in larger samples to identify targets for interventions to enhance pain management while reducing opioid-related risk and side effects.
阿片类镇痛药常用于家庭环境中，以治疗镰状细胞病（SCD）青少年的阵发性疼痛。鉴于包括便秘和镇静在内的不良副作用风险，了解与家庭中使用阿片类药物相关的因素对于最大限度地缓解疼痛而最小化负面副作用非常重要。
本研究旨在评估个体心理因素（疼痛灾难化和负性情绪）、照顾者心理因素（对儿童疼痛的灾难化和照顾者负性情绪）与 SCD 青少年家庭中阿片类药物使用之间的关系。
在常规门诊血液学就诊期间招募了 SCD 青少年（n = 32）及其照顾者（n = 28），他们完成了电子 14 天日记，评估疼痛、阿片类药物使用和心理因素。
约 28%的青少年（n = 9）报告疼痛≥50%的日记天数，三分之一的青少年（n = 11，34%）至少有一天使用阿片类镇痛药。使用阿片类镇痛药的天数范围从 0 到 7（占日记天数的 50%）。广义线性混合模型的结果表明，当考虑疼痛强度时，儿童负性情绪增加会增加某一天使用阿片类药物的几率。照顾者对儿童疼痛的灾难化程度越高，儿童使用阿片类药物的几率也越高。
儿童和父母的心理因素与 SCD 相关疼痛的儿童家庭中阿片类药物的使用有关。未来需要在更大的样本中进行研究，以确定干预目标，以加强疼痛管理，同时减少阿片类药物相关的风险和副作用。
