PAIN ASSESSMENT AND MANAGEMENT IN SICKLE CELL DISEASE

该提案将对以下方面进行全面的前瞻性评估： 非裔美国人血管闭塞性疼痛的特点 儿童和青少年镰状细胞病（SCD），以确定 导致对镇痛治疗反应不良的因素。我们 假设对镇痛治疗的不良临床反应是 多因素事件，包括潜在的贡献， 疼痛体验的特征（疼痛强度），从 药物治疗（改变药物清除率、生物利用度或改变 剂量-反应关系），并从患者的心理 美德.先知-愿此外，我们还将研究有助于 我们认为有必要利用医院为基础的服务， 患有SCD的患者和家庭用于治疗疼痛发作。我们 假设这种行为可以通过修改后的压力来预测- 心理调适模式这些研究是更大计划的一部分 确定SCD患者缺氧的患病率和病因， 与血管闭塞性疼痛的关系，并检查 脂氧合酶代谢产物介导缺氧对 内皮细胞-红细胞相互作用。 这项建议将是第一项具体描述 门诊和住院治疗的疼痛发作的疼痛强度 在大量儿童中进行前瞻性设计， 青少年SCD更重要的是，这项研究将探讨几个 这些患者的疼痛经历的其他方面， 在任何深度的研究。我们会进行第一次详细研究 静脉注射和口服吗啡和可待因的药代动力学 SCD患者我们还将进行药效学研究， 静脉注射吗啡的剂量反应关系， 对CO2的缓解反应和PCA介导的镇痛。最后我们将 检查患者的心理和社会心理属性， 经历痛苦的事件，并描述那些预测 心理调整、报告的疼痛严重程度或住院服务 利用率 虽然这些研究中的每一项都可以单独进行， 这些研究在相同患者人群中的组合， 前瞻性的基础上，将产生丰富的比较信息， 将使我们能够评估一套全面的 预测镇痛药临床反应的生物心理社会因素 治疗疼痛发作，最频繁和衰弱 SCD并发症有了这些知识，我们将能够更好地 减轻这些患者的痛苦和痛苦，并改善他们的 生活质量，直到明确的抗镰状化治疗成为一部分， 我们对患有SCD的儿童和青少年的常规临床实践。

This proposal will perform a comprehensive prospective assessment of the characteristics of the vaso-occlusive pain experience in African-American children and adolescents with Sickle Cell Disease (SCD) to determine the factors that contribute to a poor response to analgesic therapy. Our hypothesis is that poor clinical responses to analgesic therapy are a multi-factorial event that include potential contributions from characteristics of the pain experience (pain intensity), from the pharmacologic therapy (altered drug clearance, bioavailability, or altered dose-response relationship), and from the patient's psychological attributes. In addition, we will also examine factors that contribute to the perceived necessity for utilization of hospital-based services by our patients and families with SCD for treatment of painful episodes. Our hypothesis is that this behavior can be predicted by a modified stress- psychological adjustment model. These studies are part of larger program that is determining the prevalence and etiology of hypoxia in SCD and its relationship with vaso-occlusive pain, and examining the role of lipoxygenase metabolites in mediating the effects of hypoxia on endothelial cell - red cell interactions. This proposal will be the first study to specifically characterize the pain intensity of both outpatient and hospital-treated painful episodes with a prospective design in a large population of children and adolescents with SCD. More importantly, this study will examine several other facets of the pain experience in these patients that have not been previously studied in any depth. We will conduct the first detailed study of the pharmacokinetiCs of intravenous and oral morphine and codeine in patients with SCD. We will also conduct a study of the pharmacodynamics of intravenous morphine by characterizing the dose response relationship for ventilatory response to CO2 , and PCA-mediated analgesia. Finally, we will examine the psychological and psychosocial attributes of patients who experience painful episodes, and characterize those factors that predict psychological adjustment, reported pain severity, or hospital service utilization. While each one of these studies could be done in isolation, the combination of these studies in the same patient population, on a prospective basis, will yield a wealth of comparative information that will allow us to assess the relative importance of a comprehensive set of biopsychosocial factors which predict clinical response to analgesic therapy for painful episodes, the most frequent and debilitating complication of SCD. With this knowledge, we will be better able to alleviate the pain and suffering of these patients, and improve their quality of life until definitive anti-sickling therapy becomes a part of our routine clinical practice for children and adolescents with SCD.