Identifying Pain Trajectories In Sickle Cell Disease Using Latent Class Analysis

项目摘要/摘要 镰状细胞病(SCD)是一组可遗传的红细胞疾病，主要影响 认为自己是黑人或非裔美国人。其他受影响的群体包括西班牙裔、南欧人、 中东人和亚裔印度人后裔。SCD的特点是痛苦的血管闭塞危象(VOC)， 它仍然没有得到很好的理解或管理。这可能会导致治疗延误、治疗不足和 不必要的痛苦。由于SCD主要影响非裔美国人和其他少数群体，不信任 患者和提供者之间的差异可能会使SCD患者面临更高的医疗保健差异风险，包括 减少获得必要的疼痛治疗。对于大多数患者来说，疼痛是在家中管理的，而且 导致医护人员低估SCD疼痛的患病率和影响。 然而，当VOC患者出现剧烈症状时，他们通常已经耗尽了家庭护理和门诊治疗 治疗，从而表明需要非肠外阿片类药物。使用对150名患者的回顾队列 SCD在一个城市学术医学中心住院，本研究的总体目标是发展 描述镰状细胞疼痛轨迹的方法学。具体地说，目的是(1)利用潜在类 分析确定镰状细胞疼痛危象住院期间不同疼痛轨迹的模式 确定与不同疼痛轨迹相关的社会人口学和临床因素；(2)描述 治疗管理策略与住院期间镰状细胞疼痛评分的关系； 以及(3)评估不同类型的镰状细胞疼痛轨迹与未来再入院的关系 为镰状细胞疼痛危机。拟议研究的结果可用于开展前瞻性研究，以 更好地测量住院期间的疼痛或确定影响疼痛轨迹的因素，这可以是 用于针对干预或疼痛管理方法。此外，更好地描述了疼痛 SCD的疼痛轨迹和治疗尤其紧迫，因为全国正在努力限制获得 考虑到目前的滥用、成瘾和过量用药危机。患者经历了严重和 毁灭性的痛苦，例如患有SCD的人，不应该因为它们被否认是必要的而遭受痛苦。 治疗。

PROJECT SUMMARY/ABSTRACT Sickle cell disease (SCD) is a group of heritable red blood cell disorders that primarily affect individuals who identify as Black or African-American. Other affected groups include those of Hispanic, southern European, Middle Eastern, and Asian Indian descent. The hallmark of SCD is the painful vaso-occlusive crisis (VOC), which is still not well understood or managed. This may result in delays in treatment, undertreatment, and unnecessary suffering. Because SCD primarily affects African-Americans and other minority groups, mistrust between patients and providers may put patients with SCD at increased risk of healthcare disparities, including reduced access to necessary pain management. For most patients, pain is managed at home, further contributing to underestimation by healthcare practitioners of the prevalence and impact of SCD pain. However, when patients in VOC present acutely, they have usually exhausted home care and outpatient therapies, thereby signaling the need for parenteral opioids. Using a retrospective cohort of 150 patients with SCD hospitalized at one urban academic medical center, the overall goal of this study is to develop methodology to characterize the sickle cell pain trajectory. Specifically, the aims are to (1) use latent class analysis to identify different patterns of pain trajectories during hospitalizations for sickle cell pain crisis and determine socio-demographic and clinical factors associated with the different pain trajectories; (2) describe the relationship between treatment management strategies and sickle cell pain scores during hospitalization; and (3) assess the relationship between different patterns of sickle cell pain trajectories and future readmission for sickle cell pain crisis. Results from the proposed study can then be used to develop prospective studies to better measure pain during hospitalizations or to identify factors that affect the pain trajectory, which can be used to target interventions or pain management approaches. In addition, better characterization of the pain trajectory and treatment of pain in SCD are especially urgent as efforts are made nationally to restrict access to opioids given the current crisis of abuse, addiction, and overdose. Patients experiencing severe and devastating pain, such as those with SCD, should not be made to suffer because they are denied necessary treatment.