Location, Location(s), Location(s+): Moving from Acute to Chronic Pain in SCD Pain in School-Age Children

Introduction: Sickle cell disease (SCD) pain significantly impairs quality of life for children and adolescents. It is unclear when pain in SCD evolves from acute, episodic pain to chronic pain. Understanding predictors of transition from acute to chronic pain among individuals with SCD is essential to inform prevention efforts for chronic pain. Research indicates that for older adolescents and adults (16+ years), SCD pain location changes with age (localized vs. widespread) and that pain intensity varies based on location. Less is known about differences in pain experiences for those younger than 16. This study aimed to examine the relationship between pain location, pain intensity, and age in a sample of children and adolescents (<16 years) with SCD presenting to the emergency department (ED).

Methods: Data were collected as a part of a larger study examining ED visits for patients living with SCD. Data were extracted from the medical records of patients with SCD ages 8-16 who were seen in the ED at a children's hospital in the Midwest between June 2010 and June 2018. Only patients with data for pain sites and pain intensity documented in the ED notes were included in current analyses (N = 102 patients with N = 313 unique ED visits). Pain location and intensity (0 = no pain, 10 = worst pain) were reported during the ED visit, and we used the first recorded documented location and intensity. We used independent samples t-tests to assess group differences in age and pain intensity between patients who reported one pain site and patients who reported two or more pain sites.

Results: The number of ED visits per patient ranged from one to 22 (M = 3.02, SD = 3.36), with most patients having one (48%), two (17%), or three (10%) ED visits. Average age at first ED visit was 12.06 (SD = 2.65), and Average age at the last ED visit was 13.36 (SD = 2.75). Pain sites ranged from 1 to 4 (M = 1.40, SD = 0.67), with the mode being 1 (69.3%). Patients who reported 2 or more pain sites were significantly older (t(311) = -2.843, p = .005) and had significantly higher pain intensity than those who reported one pain site (t(311) = -2.264, p = .024).

Discussion: Similar to prior research, our findings suggest that the presentation of SCD pain changes with age; this study extends those findings to late childhood and early adolescence. Monitoring the emergence of increasingly multifocal or widespread pain among youth with SCD could facilitate preventive or early intervention for chronic pain, including use of interdisciplinary pain management strategies. Additional research is needed to understand pain trajectories over this developmental period as well as the best ways to support patients through changes to pain presentation.

Hood:Genomics England: Consultancy. Quinn:Disc Medicine: Consultancy; Hillhurst Biopharmaceuticals: Consultancy; Aruvant: Research Funding; Emmaus Medical: Research Funding. Crosby:Novo Nordisk (Forma Therapeutics): Membership on an entity's Board of Directors or advisory committees; Professional Resource Exchange: Patents & Royalties; Sobi: Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria; Takeda: Membership on an entity's Board of Directors or advisory committees; Sanofi Genzyme: Membership on an entity's Board of Directors or advisory committees.