A Multidimensional Understanding of Pain Among Adolescents and Adults with Sickle Cell Disease: A Prospective, Predictive, Correlational Study

Abstract

Sickle Cell Disease (SCD) is a disorder that disrupts the lives of thousands of Americans and causes recurring pain. Multidimensional factors including centralized pain, pain catastrophizing, and centrally-mediated symptoms, or the S.P.A.C.E. symptom cluster (i.e., sleep impairment, widespread pain, depression, anxiety, cognitive function, and fatigue) influence pain perception. Having comprehensive knowledge of the SCD-associated pain characteristics could lead to more effective pain management approaches. However, little SCD research has evaluated the incidence and severity of these multidimensional factors.

The purpose of this longitudinal study was to: 1) describe the incidence and severity of several pain influencing factors including pain catastrophizing, centralized pain, and S.P.A.C.E. symptoms (sleep impairment, multifocal pain, depression, anxiety, cognitive function, fatigue) in adolescents and young adults with SCD, 2) evaluate the predictive relationships among S.P.A.C.E. symptoms, opioid consumption, and pain interference, 3) examine the predictive relationships among pain catastrophizing, centralized pain, opioid consumption, and pain interference, and 4) characterize the co-occurrence of baseline S.P.A.C.E. symptoms, pain interference, opioid consumption, pain intensity, and Pain Area and Intensity Number Summation [P.A.I.N.S. (a metric that combines pain intensity and widespread pain)].

Forty-eight adolescents and adults with SCD were recruited from Pediatric and Adult Sickle Cell Clinics. Participants completed baseline measures of pain catastrophizing, centralized pain, S.P.A.C.E. symptoms, pain intensity, and P.A.I.N.S. After the completion of baseline measures, participants completed weekly opioid consumption and pain interference surveys.

Two-part models were used to analyze the predictive relationships among the multidimensional factors, weekly pain interference, and average daily opioid consumption. Multiple Spearman correlations were calculated to characterize the co-occurrence of baseline S.P.A.C.E. symptom severity scores, pain interference, average daily opioid consumption, pain intensity, and P.A.I.N.S.

Baseline depression, anxiety, and pain catastrophizing severity were low. One-fourth of participants were positive for centralized pain. Widespread pain (β=0.16; p < 0.05) and centralized pain (β=0.13; p < 0.05) were the only factors that significantly predicted increased opioid consumption. Pain catastrophizing had a significant negative relationship with opioid consumption (β=-0.03; p < 0.05). Within the pain interference models, fatigue (β=0.04; p < 0.05) and centralized pain (β=0.06; p < 0.05) were the only factors that significantly predicted more pain interference over time. Many S.P.A.C.E. symptoms (i.e., sleep impairment, anxiety, depression, cognitive function, and fatigue) were moderately and significantly correlated with one another. Pain interference was moderately and significantly correlated with all but one S.P.A.C.E. symptom (depression). Widespread pain was the only S.P.A.C.E. symptom that was significantly associated with average daily opioid consumption, pain intensity, and P.A.I.N.S.

Our findings demonstrate significant predictive relationships between centralized pain, opioid consumption, and pain. The results of this study should be interpreted with caution due to suboptimal data completion rates, small sample size, and low symptom severity. Routine assessment of centralized pain may facilitate the implementation of individualized pain management approaches, which may subsequently reduce pain and opioid use and improve function and quality of life among patients with SCD.