Daily assessment of pain in adults with sickle cell disease
Daily assessment of pain in adults with sickle cell disease
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DOI：
10.7326/0003-4819-148-2-200801150-00004
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发表时间：
2008-01-15
影响因子：
39.2
通讯作者：
Roseff, Susan D.
中科院分区：
文献类型：
--
作者：
Smith, Wally R.;Penberthy, Lynne T.;Roseff, Susan D.
背景：镰状细胞疾病的研究人员传统上将医疗保健利用作为疼痛和潜在的血管闭塞的代用品。目的：研究成人镰状细胞疾病患者自我报告疼痛的发生率以及疼痛、危机和利用之间的关系。设计：前瞻性队列研究。背景：弗吉尼亚州的学术和社区实践。患者：232名年龄在16岁或以上的镰状细胞疾病患者。测量：患者每天写日记长达6个月，记录他们最大的疼痛(从0到9分)；他们是否处于危机中(危机日)；以及他们是否在前一天(使用日)使用医院、急救或非计划的门诊护理来止痛。摘要测量包括疼痛天数、危机天数和利用天数的简单比例和调整概率(患者内部重复测量)，以及平均疼痛强度。结果：在31017个分析患者日中，54.5%的患者报告了疼痛(有或无危机或医疗利用)(调整概率为56%)。没有使用的危机报告的天数为12.7%，使用的天数仅为3.5%(未调整)。总体而言，29.3%的患者在日记中报告的疼痛天数超过95%，而只有14.2%的患者报告在5%或更少的日记天数(调整后)。家庭阿片类药物的使用频率各不相同，并独立预测疼痛、危机和利用。危急天数、非危急疼痛天数和总疼痛天数的平均疼痛强度随着疼痛天数百分比的增加而增加(P<；0.001)。利用天数强度显著高于利用天数(P<；0.001)。然而，在控制了疼痛强度后，利用并不是危机的独立预测因素。限制：这项研究是在单一状态下进行的。患者并不总是发送他们的日记。结论：患有镰状细胞疾病的成年人的疼痛是规则而不是例外，比以前的大规模研究所描绘的更普遍和严重。它大多在家中管理；因此，其流行率可能被卫生保健提供者低估，导致分类错误、沟通扭曲和治疗不足。
Background: Researchers of sickle cell disease have traditionally used health care utilization as a proxy for pain and underlying vaso-occlusion. However, utilization may not completely reflect the amount of self-reported pain or acute, painful episodes (crises).Objective: To examine the prevalence of self-reported pain and the relationship among pain, crises, and utilization in adults with sickle cell disease.Design: Prospective cohort study.Setting: Academic and community practices in Virginia.Patients: 232 patients age 16 years or older with sickle cell disease.Measurements: Patients completed a daily diary for up to 6 months, recording their maximum pain (on a scale of 0 to 9); whether they were in a crisis (crisis day); and whether they used hospital, emergency, or unscheduled ambulatory care for pain on the, previous day (utilization day). Summary measures included both simple proportions and adjusted probabilities (for repeated measures within patients) of pain days, crisis days, and utilization days, as well as mean pain intensity.Results: Pain (with or without crisis or utilization of care) was reported on 54.5% of 31 017 analyzed patient-days (adjusted probability, 56%). Crises without utilization were reported on 12.7% of days and utilization on only 3.5% (unadjusted). In total, 29.3% of patients reported pain in greater than 95% of diary days, whereas only 14.2% reported pain in 5% or fewer diary days (adjusted). The frequency of home opiate use varied and independently predicted pain, crises, and utilization. Mean pain intensity on crisis days, noncrisis pain days, and total pain days increased as the percentage of pain days increased (P < 0.001). Intensity was significantly higher on utilization days (P < 0.001). However, utilization was not an independent predictor of crisis, after controlling for pain intensity.Limitations: The study was done in a single state. Patients did not always send in their diaries.Conclusion: Pain in adults with sickle cell disease is the rule rather than the exception and is far more prevalent and severe than previous large-scale studies have portrayed. It is mostly managed at home; therefore, its prevalence is probably underestimated by health care providers, resulting in misclassification, distorted communication, and undertreatment.