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A Novel Measure of Pain Location in Adults with Sickle Cell Disease

Published:October 16, 2022DOI:https://doi.org/10.1016/j.pmn.2022.09.004

      Abstract

      Background

      Pain intensity remains a primary focus clinically for sickle cell disease pain assessment despite the fact that pain quality and pain location and distribution are critical for clinical diagnosis and treatment of its etiology. However, in part because of measurement issues, scant evidence is available about pain location or its relationship to intensity and quality in adults with SCD.

      Aim

      Our study aim was to examine sickle cell disease pain location for relationships with pain quality and intensity measured in outpatient and inpatient settings.

      Methods

      We used an existing longitudinal dataset prospectively collected with the valid and reliable tablet-based PAINReportIt. Adults with sickle cell disease (n = 99) reported pain location, intensity, and quality during a routine outpatient clinic visit and again during a subsequent hospitalization. From their digital body outline drawings and using the ImageJ software, we computed the pain-affected body surface area. With Pearson's correlations and paired t tests, we examined relationships between pain-affected body surface area and other pain variables across outpatient and inpatient visits.

      Results

      The mean pain-affected body surface area was 14.4% ± 15.0% of the total body surface area for outpatient visits (min-max: 0.0%-90.2%) and 13.5% ± 14.7% (min-max: 0.0%-73.0%) for inpatient stay. Pain-affected body surface area was positively correlated with pain quality scores for both visits but not significantly correlated with pain intensity at either visit. Compared with the outpatient visit, mean pain intensity for inpatient stay was higher (p < .001); pain quality (p = .12) and pain-affected body surface area (p = .60) did not differ significantly between visits.

      Conclusions

      Unknown is the explanation for pain-affected body surface area association with SCD pain quality but not pain intensity at outpatient and inpatient visits. Additional research is warranted to explore these findings and examine the clinical utility of pain-affected body surface area for chronic sickle cell disease pain and acute sickle cell disease crisis pain.
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      References

        • Abudawood K.
        • Yoon S.L.
        • Garg R.
        • Yao Y.
        • Molokie R.E.
        • Wilkie D.J.
        Quantification of patient-reported pain locations: Development of an automated measurement method.
        CIN: Computers, Informatics, Nursing. 2022; (Advanced online publication)https://doi.org/10.1097/cin.0000000000000875
        • Ballas S.K.
        • Lieff S.
        • Benjamin L.J.
        • Dampier C.D.
        • Heeney M.M.
        • Hoppe C.
        • Johnson C.S.
        • Rogers Z.R.
        • Smith-Whitley K.
        • Wang W.C.
        • Telen M.J.
        Definitions of the phenotypic manifestations of sickle cell disease.
        American Journal of Hematology. 2010; 85: 6-13
        • Barbero M.
        • Fernandez-de-Las-Penas C.
        • Palacios-Cena M.
        • Cescon C.
        • Falla D.
        Pain extent is associated with pain intensity but not with widespread pressure or thermal pain sensitivity in women with fibromyalgia syndrome.
        Clinical Rheumatology. 2017; 36: 1427-1432
        • Barbero M.
        • Moresi F.
        • Leoni D.
        • Gatti R.
        • Egloff M.
        • Falla D.
        Test-retest reliability of pain extent and pain location using a novel method for pain drawing analysis.
        European Journal of Pain. 2015; 19: 1129-1138
        • Benjamini Y.
        • Hochberg Y.
        Controlling false discovery rate: a practical and powerful approach to multiple testing.
        Journal of Royal Statiscal Society Series B. 1995; 57: 289-300
        • Boudreau S.A.
        • Kamavuako E.N.
        • Rathleff M.S.
        Distribution and symmetrical patellofemoral pain patterns as revealed by high-resolution 3D body mapping: A cross-sectional study.
        BMC Musculoskeletal Disorders. 2017; 18: 160
        • Brousseau D.C.
        • Owens P.L.
        • Mosso A.L.
        • Panepinto J.A.
        • Steiner C.A.
        Acute care utilization and rehospitalizations for sickle cell disease.
        Journal of American Medical Association. 2010; 303: 1288-1294
        • Cruder C.
        • Falla D.
        • Mangili F.
        • Azzimonti L.
        • Araujo L.S.
        • Williamon A.
        • Barbero M.
        Profiling the location and extent of musicians' pain using digital pain drawings.
        Pain Practice. 2018; 18: 53-66
        • Dworkin R.H.
        • Turk D.C.
        • Farrar J.T.
        • Haythornthwaite J.A.
        • Jensen M.P.
        • Katz N.P.
        • Kerns R.D.
        • Stucki G.
        • Allen R.R.
        • Bellamy N.
        • Carr D.B.
        • Chandler J.
        • Cowan P.
        • Dionne R.
        • Galer B.S.
        • Hertz S.
        • Jadad A.R.
        • Kramer L.D.
        • Manning D.C.
        • Witter J.
        Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.
        Pain. 2005; 113: 9-19
        • Dyal B.W.
        • Ezenwa M.O.
        • Yoon S.L.
        • Fillingim R.B.
        • Yao Y.
        • Schlaeger J.M.
        • Suarez M.L.
        • Wang Z.J.
        • Molokie R.E.
        • Wilkie D.J.
        Relationship of pain quality descriptors and quantitative sensory testing: Sickle cell disease.
        Nursing Research. 2019; 68: 365-373
        • Dyal B.W.
        • Ezenwa M.O.
        • Yoon S.L.
        • Fillingim R.B.
        • Yao Y.
        • Schlaeger J.M.
        • Suarez M.L.
        • Wang Z.J.
        • Molokie R.E.
        • Wilkie D.J.
        A QST-based pain phenotype in adults with sickle cell disease: sensitivity and specificity of quality descriptors.
        Pain Practice. 2020; 20: 168-178
        • Ezenwa M.O.
        • Molokie R.E.
        • Wang Z.J.
        • Suarez M.L.
        • Yao Y.
        • Wilkie D.J.
        Satisfied or not satisfied: Pain experiences of patients with sickle cell disease.
        Journal of Advanced Nursing. 2016; 72: 1398-1408
        • Ezenwa M.O.
        • Molokie R.E.
        • Wang Z.J.
        • Yao Y.
        • Suarez M.L.
        • Angulo V.
        • Wilkie D.J.
        Outpatient pain predicts subsequent one-year acute health care utilization among adults with sickle cell disease.
        Journal of Pain and Symptom Management. 2014; 48: 65-74
        • Fosdal M.B.
        Perception of pain among pediatric patients with sickle cell pain crisis.
        Journal of Pediatric Oncology Nursing. 2015; 32: 5-20
        • Graven-Nielsen T.
        • Arendt-Nielsen L.
        Assessment of mechanisms in localized and widespread musculoskeletal pain.
        Nature Review Rheumatology. 2010; 6: 599-606
        • Huo J.
        • Xiao H.
        • Garg M.
        • Shah C.
        • Wilkie D.J.
        • Mainous III, A.
        The economic burden of sickle cell disease in the United States.
        Value in Health. 2018; 21: S108
        • Jacob E.
        • Miaskowski C.
        • Savedra M.
        • Beyer J.E.
        • Treadwell M.
        • Styles L.
        Changes in intensity, location, and quality of vaso-occlusive pain in children with sickle cell disease.
        Pain. 2003; 102: 187-193
        • Jha A.
        • Suarez M.L.
        • Ferrans C.E.
        • Molokie R.
        • Kim Y.O.
        • Wilkie D.J.
        Cognitive testing of PAINReportIt in adult African Americans with sickle cell disease.
        CIN: Computers, Informatics, Nursing. 2010; 28: 141-150
        • Lanzkron S.
        • Carroll C.P.
        • Haywood Jr., C.
        The burden of emergency department use for sickle-cell disease: An analysis of the national emergency department sample database.
        American Journal of Hematology. 2010; 85: 797-799
        • Lluch Girbes E.
        • Duenas L.
        • Barbero M.
        • Falla D.
        • Baert I.A.
        • Meeus M.
        • Sánchez-Frutos J.
        • Aguilella L.
        • Nijs J.
        Expanded distribution of pain as a sign of central sensitization in individuals with symptomatic knee osteoarthritis.
        Physical Therapy. 2016; 96: 1196-1207
        • Margolis R.B.
        • Tait R.C.
        • Krause S.J.
        A rating system for use with patient pain drawings.
        Pain. 1986; 24: 57-65
        • Matthews M.
        • Rathleff M.S.
        • Vicenzino B.
        • Boudreau S.A.
        Capturing patient-reported area of knee pain: A concurrent validity study using digital technology in patients with patellofemoral pain.
        PeerJ. 2018; 6: e4406
        • McClish D.K.
        • Smith W.R.
        • Dahman B.A.
        • Levenson J.L.
        • Roberts J.D.
        • Penberthy L.T.
        • Aisuiku I.P.
        • Roseff S.D.
        • Bovbjerg V.E.
        Pain site frequency and location in sickle cell disease: The PiSCES project.
        Pain. 2009; 145: 246-251
        • Melzack R.
        The McGill Pain Questionnaire: Major properties and scoring methods.
        Pain. 1975; 1: 277-299
        • Molokie R.E.
        • Wang Z.J.
        • Yao Y.
        • Powell-Roach K.L.
        • Schlaeger J.M.
        • Suarez M.L.
        • Shuey D.A.
        • Angulo V.
        • Carrasco J.
        • Ezenwa M.O.
        • Fillingham R.B.
        • Wilkie D.J.
        Sensitivities to thermal and mechanical stimuli: Adults with sickle cell disease compared to healthy, pain-free African American Controls.
        Journal of Pain. 2020; 21: 957-967
        • O'Connor A.B.
        • Dworkin R.H.
        Treatment of neuropathic pain: An overview of recent guidelines.
        American Journal of Medicine. 2009; 122: S22-S32
        • Piel F.B.
        • Hay S.I.
        • Gupta S.
        • Weatherall D.J.
        • Williams T.N.
        Global burden of sickle cell anaemia in children under five, 2010-2050: Modelling based on demographics, excess mortality, and interventions.
        PLoS Medicine. 2013; 10e1001484
        • Powell-Roach K.
        • Yao Y.
        • Ezenwa M.O.
        • Schlaeger J.M.
        • Suarez M.L.
        • Molokie R.E.
        • Wang Z.J.
        • Wilkie D.J.
        Neuropathic pain screening: construct validity in patients with sickle cell disease.
        Western Journal of Nursing Research. 2020; 42: 125-130
        • Savedra M.C.
        • Holzemer W.L.
        • Tesler M.D.
        • Wilkie D.J.
        Assessment of postoperation pain in children and adolescents using the adolescent pediatric pain tool.
        Nursing Research. 1993; 42: 5-9
        • Schneider C.A.
        • Rasband W.S.
        • Eliceiri K.W.
        NIH Image to ImageJ: 25 years of image analysis.
        Nature Methods. 2012; 9: 671-675
        • Toomey T.C.
        • Gover V.F.
        • Jones B.N.
        Site of pain: Relationship to measures of pain description, behavior and personality.
        Pain. 1984; 19: 389-397
        • Turp J.C.
        • Kowalski C.J.
        • O'Leary N.
        • Stohler C.S.
        Pain maps from facial pain patients indicate a broad pain geography.
        Journal of Dental Research. 1998; 77: 1465-1472
        • Visser E.J.
        • Ramachenderan J.
        • Davies S.J.
        • Parsons R.
        Chronic widespread pain drawn on a body diagram is a screening tool for increased pain sensitization, psycho-social load, and utilization of pain management strategies.
        Pain Practice. 2016; 16: 31-37
        • Wilkie D.
        • Lovejoy N.
        • Dodd M.
        • Tesler M.
        Cancer pain intensity measurement: Concurrent validity of three tools–finger dynamometer, pain intensity number scale, visual analogue scale.
        Hospice Journal. 1990; 6: 1-13
        • Wilkie D.J.
        • Huang H.Y.
        • Reilly N.
        • Cain K.C.
        Nociceptive and neuropathic pain in patients with lung cancer: a comparison of pain quality descriptors.
        Journal of Pain and Symptom Management. 2001; 22: 899-910
        • Wilkie D.J.
        • Johnson B.
        • Mack A.K.
        • Labotka R.
        • Molokie R.E.
        Sickle cell disease: An opportunity for palliative care across the life span.
        Nursing Clinics of North America. 2010; 45: 375-397
        • Wilkie D.J.
        • Judge M.K.
        • Berry D.L.
        • Dell J.
        • Zong S.
        • Gilespie R.
        Usability of a computerized PAINReportIt in the general public with pain and people with cancer pain.
        Journal of Pain and Symptom Management. 2003; 25: 213-224
        • Wilkie D.J.
        • Keefe F.J.
        • Dodd M.J.
        • Copp L.A.
        Behavior of patients with lung cancer: Description and associations with oncologic and pain variables.
        Pain. 1992; 51: 231-240