Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach.
Identifying Chronic Pain Subgroups in Pediatric Sickle Cell Disease: A Cluster-Analytic Approach.
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DOI：
10.1097/ajp.0000000000001065
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发表时间：
2022-10-01
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患有镰状细胞病（SCD）和慢性疼痛的青少年（在本研究中定义为持续3个月的大部分时间的疼痛）在日常疼痛、身体和社会心理功能方面存在差异。本研究的目的是：1)根据慢性SCD青年患者的疼痛特征，实证得出慢性疼痛亚组；2)调查衍生亚组在社会人口统计学、临床特征、社会心理和功能结果方面的差异。患有慢性SCD疼痛的青年（n=62, Mage=13.9， SD=2.5, 10-18岁，58%为女性，60%为HbSS）完成了一系列问卷调查。从电子病历中提取临床特征（如药物、治疗）和医疗保健利用情况。分层聚类分析告知在患者层面的聚类数量。K-means聚类分析使用多维疼痛评估来识别和分配患者。第1组（n=35；中度频率，中度疼痛）表现出较低的最严重疼痛强度、每月疼痛天数、受疼痛影响的身体部位数量和疼痛质量评分。第2组（n=27；几乎每天，高疼痛）报告了高评分的最严重疼痛强度，几乎每天到每天的疼痛，更多的身体部位受疼痛影响，更高的疼痛质量评分（所有p < 0.05）。亚组之间在社会人口统计学、临床特征或医疗保健利用方面没有差异。几乎每天，高度疼痛亚组报告的疼痛干扰，抑郁症状和疼痛灾难明显高于中等频率，中度疼痛亚组。确定慢性SCD疼痛亚组可以为量身定制的评估和干预提供信息，以减轻不良疼痛和功能结局。
Youth with sickle cell disease (SCD) and chronic pain, defined in this study as pain on most days for 3 months, experience variability in daily pain and physical and psychosocial functioning. This study aimed to 1) empirically derive chronic pain subgroups based on pain characteristics among youth with chronic SCD pain; and 2) investigate derived subgroups for differences in socio-demographics, clinical characteristics, and psychosocial and functional outcomes. Youth with chronic SCD pain (n=62, Mage=13.9, SD=2.5, 10–18 years; 58% Female, 60% HbSS) completed a battery of questionnaires. Clinical characteristics (e.g., medications, treatments) and healthcare utilization were abstracted from electronic medical records. Hierarchical cluster analysis informed the number of clusters at the patient level. K-means cluster analysis used multidimensional pain assessment to identify and assign patients to clusters. Cluster 1 (n=35; Moderate Frequency, Moderate Pain) demonstrated significantly lower worst pain intensity, number of pain days per month, number of body sites affected by pain, and pain quality ratings. Cluster 2 (n=27; Almost Daily, High Pain) reported high ratings of worst pain intensity, almost daily to daily pain, greater number of body sites affected by pain, and higher ratings of pain quality (all p’s <.05). There were no differences between subgroups by socio-demographics, clinical characteristics, or healthcare utilization. The Almost Daily, High Pain subgroup reported significantly higher pain interference, depressive symptoms, and pain catastrophizing than the Moderate Frequency, Moderate Pain subgroup. Identifying chronic SCD pain subgroups may inform tailored assessment and intervention to mitigate poor pain and functional outcomes.