Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease
Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease
复制标题
DOI：
10.1002/pbc.27823
复制
发表时间：
2019-09-01
影响因子：
3.2
通讯作者：
Hardy, Steven J.
中科院分区：
文献类型：
--
作者：
Connolly, Megan E.;Bills, Sarah E.;Hardy, Steven J.
背景疼痛是镰状细胞病(SCD)的主要并发症，包括血管闭塞危象和持续性疼痛。虽然在没有SCD的年轻人中，持续性疼痛与相当大的损害有关，但对于持续性疼痛在SCD中的功能影响，我们知之甚少。本研究的目的是(A)描述患有SCD的青少年持续性疼痛的特征，以及(B)确定患有SCD的青少年和持续性疼痛在疾病发病率、功能障碍以及神经认知和心理功能方面的不同程度。程序89名参与者(7-16岁)和照顾者完成了问卷(Brief[执行功能行为评定量表]，Conners-3[Conners-3，第三版]和PedsQL(TM)-SCD模块，其中PedsQL是儿科生活质量问卷)。参与者完成了神经认知测试WISC-V[韦氏儿童智力量表-第五版]、WJ-III[伍德科克-约翰逊成就测试-第三版]和WIAT-III[韦克斯勒个人成就测试-第三版])。如果青年每天报告疼痛持续7天，则被归类为持续性疼痛。采用卡方检验和独立样本t检验分析来评估两组间的差异(有持续性疼痛和无持续性疼痛)。结果持续性疼痛患者(n=18)健康相关生活质量较低(P=.000)。照顾者更有可能将患有持续性疼痛的年轻人评为计划/组织能力较低(P=.011)，以及临床上反抗/攻击性和对抗性反抗症状较高(P=.00；.01)。持续性疼痛患者的工作记忆较差(P=.023)，加工速度较慢(P=.027)，阅读流利性较差(P=.026)。结论青少年SCD和持续性疼痛是心理社会和神经认知障碍的危险因素，提示持续性疼痛可能是疾病负担的一个重要指标。此外，可以通过评估认知和心理社会功能并结合跨学科治疗来加强疾病管理，以解决与持续性疼痛相关的损害。
Background Pain is a major complication of sickle cell disease (SCD), spanning vaso-occlusive crises and persistent pain. Although it is known that persistent pain is associated with considerable impairment in youth without SCD, little is known about the functional effects of persistent pain in SCD. The current study aimed to (a) characterize persistent pain in youth with SCD and (b) determine the extent to which youth with SCD and persistent pain differ in disease morbidity, functional impairment, and neurocognitive and psychological functioning. Procedure Eighty-nine participants (ages 7-16) and caregivers completed questionnaires (BRIEF [Behavior Rating Inventory of Executive Function], Conners-3 [Conners-third edition], and PedsQL (TM)-SCD Module, where PedsQL is Pediatric Quality of Life Inventory). Participants completed neurocognitive tests WISC-V [Wechsler Intelligence Scale for Children-fifth edition], WJ-III [Woodcock Johnson Tests of Achievement-third edition], and WIAT-III [Wechsler Individual Achievement Test-third edition]). Youth were classified as having persistent pain if they reported daily pain for 7 days. Chi-square and independent sample t-test analyses were used to assess group differences (those with vs without persistent pain). Results Patients with persistent pain (n = 18) reported lower health-related quality of life (P = .000). Caregivers were more likely to rate youth with persistent pain as having lower planning/organization abilities (P = .011) and clinically elevated symptoms of defiance/aggression and oppositional defiance (Ps = .00; .01). Patients with persistent pain demonstrated poorer working memory (P = .023) and processing speed (P = .027), and fewer demonstrating reading fluency abilities in the average or above range (P = .026). Conclusions Youth with SCD and persistent pain are at risk for psychosocial and neurocognitive impairments, suggesting that persistent pain may be an important indicator of disease burden. Furthermore, disease management may be enhanced by assessing cognitive and psychosocial functioning and incorporating interdisciplinary treatments addressing impairment associated with persistent pain.