Department of Anesthesiology, Division of Pediatric Anesthesiology, Duke University, Durham, North Carolina.
Department of Medicine, Division of Hematology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina; UNC Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Pain. 2024 Jan;25(1):153-164. doi: 10.1016/j.jpain.2023.07.029. Epub 2023 Aug 5.
Pain is the primary symptomatic manifestation of sickle cell disease (SCD), an inherited hemoglobinopathy. The characteristics that influence pain experiences and outcomes in SCD are not fully understood. The primary objective of this study was to use multivariable modeling to examine associations of biopsychosocial variables with a disease-specific measure of pain interference known as pain impact. We conducted a secondary analysis of data from the Global Research Network for Data and Discovery national SCD registry. A total of 657 children and adults with SCD were included in the analysis. This sample was 60% female with a median age of 34 (interquartile range 26-42 years) and a chronic pain prevalence of 64%. The model accounted for 58% of the variance in pain impact. Low social (P < .001) and emotional (P < .001) functioning, increasing age (P = .004), low income (P < .001), and high acute painful episodes (P = .007) were most strongly associated with high pain impact in our multivariable model. Additionally, multivariable modeling of pain severity and physical function in 2 comparable samples of registry participants revealed that increasing age and low social functioning were also strongly associated with higher pain severity and low physical functioning. Overall, the results suggest that social and emotional functioning are more strongly associated with pain impact in individuals with SCD than previously studied biological modifiers such as SCD genotype, hemoglobin, and percentage fetal hemoglobin. Future research using longitudinally collected data is needed to confirm these findings. PERSPECTIVE: This study reveals that psychosocial (ie, social and emotional functioning) and demographic (ie, age) variables may play an important role in predicting pain and pain-related outcomes in SCD. Our findings can inform future multicenter prospective longitudinal studies aimed at identifying modifiable psychosocial predictors of adverse pain outcomes in SCD.
疼痛是镰状细胞病（SCD）的主要症状表现，这是一种遗传性血红蛋白病。影响 SCD 患者疼痛体验和结局的特征尚未完全明确。本研究的主要目的是使用多变量模型来研究生物心理社会变量与特定疾病疼痛干扰的关联，这种特定疾病疼痛干扰通常用疼痛影响来衡量。我们对全球数据和发现研究网络的国家 SCD 登记处的数据进行了二次分析。共纳入了 657 例 SCD 儿童和成人患者。该样本中 60%为女性，中位年龄为 34 岁（四分位间距为 26-42 岁），慢性疼痛患病率为 64%。该模型解释了疼痛影响 58%的方差。低社会（P<0.001）和情绪（P<0.001）功能、年龄增长（P=0.004）、低收入（P<0.001）和高急性疼痛发作（P=0.007）与我们多变量模型中的高疼痛影响最相关。此外，在 2 个具有可比性的登记参与者样本中对疼痛严重程度和身体功能进行的多变量建模显示，年龄增长和低社会功能也与更高的疼痛严重程度和低身体功能高度相关。总体而言，结果表明，在 SCD 患者中，社会和情绪功能与疼痛影响的相关性比之前研究的生物修饰因子（如 SCD 基因型、血红蛋白和胎儿血红蛋白百分比）更强。需要使用纵向收集的数据开展未来研究来证实这些发现。观点：本研究揭示了心理社会（如社会和情绪功能）和人口统计学（如年龄）变量可能在预测 SCD 中的疼痛和与疼痛相关的结局方面发挥重要作用。我们的研究结果可以为未来旨在确定 SCD 中不良疼痛结局的可改变心理社会预测因素的多中心前瞻性纵向研究提供信息。
