Poster Board I-558
Pain in sickle cell disease (SCD) is a common acute and chronic complication across the life span, but a single multidimensional pain assessment tool is not available that can be used in children, adolescents and adults. The Adolescent Pediatric Pain Tool (APPT) is a self-administered, paper and pencil tool that has been validated in children and adolescents with SCD; the McGill Pain Questionnaire (MPQ) is valid for adolescents and adults. To begin to create a multidimensional pain assessment tool that is valid across the life span, we compared the APPT to the PAINReportIt®, a self-administered computerized version of the MPQ in adolescent outpatients with SCD. The use of a computer/web based system would allow for ease of storage and retrieval of data. The utilization of a computerized pain assessment tool may provide clues to treatment of the multidimensional pain experience of pediatric patients with SCD.
Patients with sickle cell disease (Hb SS, Hb SC, Hb Sβ0 and Hb Sβ+ thalassemia) aged 14 years of age and older were eligible for this study. A convenience sample of patients attending comprehensive sickle cell clinics were recruited for enrollment. In random order, on the same day, patients completed the PAINReportIt® and the APPT in an outpatient clinic. The number of pain sites, pain intensity, qualitative pain descriptors (sensory, affective, and evaluative), pain pattern, as well as nociceptive and neuropathic descriptors were analyzed with descriptive, correlation, and independent t-test statistics.
A total of 49 patients completed both pain assessment tools. 26 were female (53%) and 23 were male (47%). 41 (84%) patients had Hb SS, 7 (14.3%) had Hb SC, and 1 patient (2%) had Hb SB0 thalassemia. 46 (94%) of the patients described themselves as African American, 2 (4%) as Hispanic, and one (2%) as other. The mean number of pain sites with PAINReportIt® was 3.65 +/- 3.4; the mean number of pain sites with the APPT was 4.71 +/- 4.87 (r= 0.76, p= 0.01). Pain sites where more than 25% of the patients had pain included the chest, abdomen and forearm. More than 35% of the patients had pain in the thighs, knees and lower legs, and 59% of the patients reported pain in the lower back. The pain intensity with PAINReportIt® was 3.76 +/- 2.53 (on a 10-point scale) and with the APPT was 4.63 +/- 3.12 (on a 10-point scale) (r= 0.29, p= 0.05). In terms of qualitative pain descriptors between the tools, sensory (r= 0.69, p= 0.01), affective (r= 0.69, p= 0.01), and evaluative (r= 0.48, p= 0.001) terms each had a statistically significant correlation. There also was a statistically significant correlation between tools with the patient's pain pattern (r= 0.35, p= 0.01). There was a statistically significant difference by gender with the number of pain sites (females: 4.88 +/- 4.07, males: 2.26 +/-1.60, p= 0.005), and with the following qualitative pain descriptors: neuropathic (females: 4.31 +/- 3.08, males: 2.04 +/- 1.89, p= 0.03), nociceptive (females: 6.58 +/- 3.97, males: 3.91 +/- 2.71, p= 0.008), sensory (females: 17.54 +/- 8.29, males: 12.69 +/- 7.11, p= 0.03) and affective (females: 4.65 +/- 4.08, males: 2.27 +/- 2.70, p= 0.02). There was a statistically significant correlation with both tools regardless of which tool was completed first for the number of pain sites and with the use of sensory and affective qualitative descriptive terms (data not shown).
There were significant, moderate to strong correlations between the PAINReportIt® and the APPT with regard to pain location, intensity, quality and pattern, validating the use of PAINReportIt® in adolescent patients with SCD. This is the first study utilizing this important tool in pediatric patients with SCD. The minor differences in scores between the two tools may reflect differences in instructions. This computerized pain assessment tool may become an important diagnostic tool to assist pediatric practitioners in the management of the multidimensional components of pain in SCD.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.