Presence of pain on three or more days of the week is associated with worse patient reported outcomes in adults with sickle cell disease
Presence of pain on three or more days of the week is associated with worse patient reported outcomes in adults with sickle cell disease
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DOI：
10.2147/jpr.s150065
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发表时间：
2018-01-01
影响因子：
2.7
通讯作者：
Krishnamurti, Lakshmanan
中科院分区：
文献类型：
--
作者：
Bakshi, Nitya;Ross, Diana;Krishnamurti, Lakshmanan
虽然急性发作性疼痛是镰状细胞病（SCD）的标志，但转变为慢性疼痛是发病和生活质量受损的主要原因。镇痛、麻醉和成瘾临床试验转化创新机会和网络-美国疼痛学会疼痛分类法（AAPT）用于定义慢性SCD疼痛的核心诊断标准之一是在过去6个月内在一个或多个位置的“大部分时间”存在疼痛。“大部分天数”的频率特征改编自用于定义慢性偏头痛的每月15天或以上的标准，但没有足够的数据支持SCD中的这一截止值。使用现有的成人SCD患者数据集，这些患者使用美国国立卫生研究院（NIH）患者报告结果测量信息系统（PROMIS）短格式工具完成疼痛干扰，身体功能，焦虑，抑郁和疲劳的患者报告结果，我们检查了每周3天或以上疼痛与患者报告功能结果的相关性。在未校正的分析中，每周3天或以上的疼痛与疼痛干扰、焦虑和抑郁的中位PROMIS评分较高相关。在未调整的分析中，女性的疲劳和身体功能的中位PROMIS评分比男性差。我们未发现年龄≥ 35岁的成人之间的中位PROMIS疼痛评分存在任何差异。在线性回归模型中，在调整年龄和性别后，发现每周3天或3天以上疼痛的存在与更严重的疼痛干扰和焦虑有关。这些数据支持慢性SCD疼痛定义中“大多数天数”疼痛频率特征的临床相关性，并为前瞻性研究提供了验证SCD慢性疼痛临床定义的依据。
While acute episodic pain is the hallmark of sickle cell disease (SCD), transition to chronic pain is a major cause of morbidity and impaired quality of life. One of the core diagnostic criteria used by Analgesic, Anesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy (AAPT) to define chronic SCD pain is the presence of pain on a "majority of days" in the past 6 months in one or more locations. The frequency characteristic of "majority of days" is adapted from the criteria of 15 days or more per month, used to define chronic migraine, but there are inadequate data to support this cutoff in SCD. Using an existing dataset of adults with SCD who completed patient-reported outcomes of pain interference, physical functioning, anxiety, depression, and fatigue using the National Institutes of Health (NIH) patient-reported outcomes measures information system (PROMIS) short-form instruments, we examined the association of the presence of pain on 3 or more days per week with patient-reported outcomes of functioning. In unadjusted analyses, presence of pain on 3 or more days a week was associated with higher median PROMIS scores of pain interference, anxiety, and depression. Median PROMIS scores of fatigue and physical function were worse in women compared with men in unadjusted analyses. We did not find any difference in median PROMIS pain scores between adults aged = 35 years. In linear regression models, after adjustment for age and sex, the presence of pain on 3 or more days a week was found to be associated with worse pain interference and anxiety. These data support the clinical relevance of the frequency characteristic of pain on a "majority of days" in the definition of chronic SCD pain, and provide the rationale for prospective studies to validate the clinical definition of chronic pain in SCD.