Open Access Open Access  Restricted Access Subscription or Fee Access

Daily home opioid use in adults with sickle cell disease: The PiSCES project

Wally R. Smith, MD, Donna K. McClish, PhD, Bassam A. Dahman, PhD, James L. Levenson, MD, Imoigele P. Aisiku, MD, MSCR, Vanessa de A. Citero, MD, Viktor E. Bovbjerg, PhD, MPH, John D. Roberts, MD, Lynne T. Penberthy, MD, MPH, Susan D. Roseff, MD

Abstract


Background: Although opioid prescribing in sickle cell disease (SCD) can be controversial, little is published about patterns of opioid use.

Objective: To report on home opioid use among adults with SCD.

Design: Cohort study.

Participants: Adults with SCD (n = 219) who completed daily pain diaries for up to 6 months and had at least one home pain day.

Main measures: Use of long-acting or short-acting opioids, other analgesics, or adjuvants; the proportion of home days, home pain days, and home crisis days with opioid use; these two outcomes according to patient characteristics.

Key results: Patients used opioids on 12,311 (78 percent) of 15,778 home pain days. Eighty-five patients (38.8 percent) used long-acting opioids with or without short-acting opioids and 103 (47.0 percent) used only short-acting opioids. Twenty-one (9.6 percent) patients used only non-opioid analgesics and 10 (4.6 percent) used no analgesics. Both pain intensity and pain frequency were higher among opioid users (analysis of variance [ANOVA], p < 0.0001). Opioid users used hydroxyurea more often than nonusers, even when controlling for mean pain on pain days. Among all patients, significant relationships were found between any opioid use and somatic symptom burden, SCD stress, negative coping, and physical and mental quality of life (QOL); the relationship with SCD stress and physical QOL remained when controlled for mean pain. Among opioid users, similar associations were found between frequency of opioid use and some disease-related and psychosocial variables.

Conclusions: In this adult SCD sample, opioids were used by the majority of patients. Pain was the overwhelming characteristic associated with use, but disease-related and psychosocial variables were also associated.


Keywords


sickle cell disease, pain, long-term opioid therapy, epidemiology

Full Text:

PDF

References


Serjeant GR, Serjeant BE: Management of sickle cell disease; lessons from the Jamaican Cohort Study. Blood Rev. 1993; 7(3): 137-145.

Serjeant GR: Sickle-cell disease. Lancet. 1997; 350(9079): 725-730.

Smith WR, McClish DK, Penberthy LT, et al.: Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 2008; 148(2): 94-101.

Charache S, Terrin ML, Moore RD, et al.: Effect of hydroxyurea on frequency of painful crises in sickle cell anemia. N Engl J Med. 1995; 332: 1317-1322.

Steinberg MH, Barton F, Castro O, et al.: Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia: Risks and benefits up to 9 years of treatment. JAMA. 2003; 289: 1645-1651.

Ballantyne JC, Mao J: Opioid therapy for chronic pain. N Engl J Med. 2003; 349(20): 1943-1953.

Adams LL, Gatchel RJ, Robinson RC, et al.: Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain patients. J Pain Symptom Manage. 2004; 27(5): 440-459.

Compton P, Darakjian J, Miotto K: Screening for addiction in patients with chronic pain and “problematic” substance use: Evaluation of a pilot assessment tool. J Pain Symptom Manage. 1998; 16(6): 355-363.

Chabal C, Erjavec MK, Jacobson L, et al.: Prescription opioid abuse in chronic pain patients: Clinical criteria, incidence, and predictors. Clin J Pain. 1997; 13(2): 150-155.

Sullivan MD, Edlund MJ, Steffick D, et al.: Regular use of prescribed opioids: Association with common psychiatric disorders. Pain. 2005; 119(1-3): 95-103.

Jensen MK, Thomsen AB, Højsted J: 10-Year follow-up of chronic non-malignant pain patients: Opioid use, health related quality of life and health care utilization. Eur J Pain. 2006; 10(5): 423-433.

Rosenblum A, Marsch LA, Joseph H, et al.: Opioids and the treatment of chronic pain: Controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008; 16(5): 405-416.

Eriksen J, Sjøgren P, Bruera E, et al.: Critical issues on opioids in chronic non-cancer pain: An epidemiological study. Pain. 2006; 125(1-2): 172-179.

Savage SR, Kirsh KL, Passik SD: Challenges in using opioids to treat pain in persons with substance use disorders. Addict Sci Clin Pract. 2008; 4: 4-25.

National Institutes of Health, National Heart, Lung, and Blood Institute, Division of Blood Diseases and Resources: The Management of Sickle Cell Disease. 4th ed. NIH Publication 2002-2117. Bethesda, MD: National Institutes of Health, June 2002.

Benjamin LJ, Dampier CD, Jacox A, et al.: Standards for Management of Acute and Chronic Sickle Cell Pain. Chicago, IL: American Pain Society, 1999.

Rees D: Guidelines for the management of the acute painful crisis of sickle cell disease. Brit J Haematol. 2003; 120: 744-752.

Jacob E: Pain management in sickle cell disease. Pain Manag Nurs. 2001; 2(4): 121-131.

Fultz JM, Senay EC: Guidelines for the management of hospitalized narcotics addicts. Ann Intern Med. 1975; 82(6): 815-818.

Tennant FS Jr, Uelmen GF: Prescribing narcotics to habitual and addicted narcotic users. Medical and legal guidelines in California and some other Western states. West J Med. 1980; 133(6): 539-545.

Brozovic M, Davies SC, Yardumian A, et al.: Pain relief in sickle cell crisis. Lancet. 1986; 2(8507): 624-625.

Vichinsky EP, Johnson R, Lubin BH: Multidisciplinary approach to pain management in sickle cell disease. Am J Pediatr Hematol Oncol. 1982; 4(3): 328-333.

Smith WR, Bovbjerg VE, Penberthy LT, et al.: Understanding pain and improving management of sickle cell disease: The PiSCES study. J Natl Med Assoc. 2005; 97: 183-193.

McClish DK, Levenson JL, Penberthy LT, et al.: Gender differences in pain and healthcare utilization for adult sickle cell patients: The PiSCES Project. J Womens Health (Larchmt). 2006; 15: 146-154.

Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992; 30: 473-483.

Kroenke K, Spitzer RL, Williams JBW, et al.: The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales (PHQ-SADS): A systematic review. Gen Hosp Psychiatry. 2010; 32: 345-359.

Sogutlu A, Levenson JL, McClish DK, et al.: Somatic symptom burden in adults with sickle cell disease predicts pain, depression, anxiety, health care utilization, and quality of life: The PiSCES project. Psychosomatics. 2011; 52(3): 272-279.

Rosentheil AK, Keefe FJ: The use of coping strategies in low back pain patients: Relationship to patient characteristics and current adjustment. Pain. 1983; 17: 33-44.

Kazarian SS, McCabe SB: Dimensions of social support in the MSPSS: Factorial structure, reliability, and theoretical implications. J Comm Psychol. 1991; 19: 150-160.

Dahlem NW, Zimet GD, Walker RR: The Multidimensional Scale of Perceived Social Support: A confirmation study. J Clin Psychol. 1991; 47: 756-761.

Ruehlman LS, Karoly P: With a little flak from my friends: Development and preliminary validation of the Test of Negative Social Exchange (TENSE). Psychol Assess. 1991; 3(1): 97-104.

Charache S, Terrin ML, Moore RD, et al.: Design of the multicenter study of hydroxyurea in sickle cell anemia. Control Clin Trials. 1995; 16: 432-446.

Fishbain DA, Cole B, Lewis JE, et al.: Do opioids induce hyperalgesia in humans?. An evidence-based structured review. Pain Med. 2009; 10(5): 829-839.

Substance Abuse and Mental Health Services Administration, Office of Applied Studies, Drug Abuse Warning Network: Interim National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-26, DHHS Publication No. (SMA) 04-3972. Rockville, MD, 2004.

Von Korff M, Deyo RA: Potent opioids for chronic musculoskeletal pain: Flying blind? Pain. 2004; 109(3): 207-209.

Streltzer J, Johansen L: Prescription drug dependence and evolving beliefs about chronic pain management. Am J Psychiatry. 2006; 163(4): 594-598.

Centers for Disease Control and Prevention (CDC): Increase in poisoning deaths caused by non-illicit drugs—Utah, 1991- 2003. MMWR Morb Mortal Wkly Rep. 2005; 54(2): 33-36.

Savage SR: Assessment for addiction in pain-treatment settings. Clin J Pain. 2002; 18(4 Suppl): S28-S38.

Gil K, Williams D, Thompson R Jr, et al.: Sickle cell disease in children and adolescents: The relation of child and parent pain coping strategies to adjustment. J Pediatr Psychol. 1991; 16: 643-663.

Weaver MF, Schnoll SH: Addiction issues in prescribing opioids for chronic nonmalignant pain. J Addict Med. 2007; 1: 2-10.

Walco G, Dampier C: Chronic pain in adolescent patients. J Pediatr Psychol. 1987; 12: 215-225.

Gil K, Abrams M, Phillips G, et al.: Sickle cell disease pain: Relation of coping strategies to adjustment. J Consult Clin Psychol. 1989; 57: 725-731.

McCrae JD, Lumley MA: Health status in sickle cell disease: Examining the roles of pain coping strategies, somatic awareness, and negative affectivity. J Behav Med. 1998; 21(1): 35-55.

Pilisuk M, Boylan R, Acredolo C: Social support, life stress, and subsequent medical care utilization. Health Psychol. 1987; 6(4): 273-288.

McHugh RK, Hearon BA, Otto MW: Cognitive behavioral therapy for substance use disorders. Psychiatr Clin North Am. 2010; 33: 511-525.

Fiellin DA, Barry DT, Sullivan LE, et al.: A randomized trial of cognitive behavioral therapy in primary care-based buprenorphine. Am J Med. 2013; 126(1): 74.e11-74.e17.

Ballas SK, Bauserman RL, McCarthy WF, et al.: Hydroxyurea and acute painful crises in sickle cell anemia: Effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home. J Pain Symptom Manage. 2010; 40(6): 870-882.

Smith WR, Ballas SK, McCarthy WF, et al.: The association between hydroxyurea treatment and pain intensity, analgesic use, and utilization in ambulatory sickle cell anemia patients. Pain Med. 2011; 12(5): 697-705.

Brookoff D, Polomano R: Treating sickle cell pain like cancer pain. Ann Intern Med. 1992; 116(5): 364-368.

Ballas SK, Rubin RN, Gabuzda TC: Treating sickle cell pain like cancer pain. Ann Intern Med. 1992; 117(3): 263; author reply 264.

Smith JA: Treating sickle cell pain like cancer pain. Ann Intern Med. 1992; 117(3): 263-264.

Portenoy RK: Treating sickle cell pain like cancer pain. Ann Intern Med. 1992; 117(3): 264-265.

Shapiro BS, Benjamin LJ, Payne R, et al.: Sickle cell-related pain: Perceptions of medical practitioners. J Pain Symptom Manage. 1997; 14(3): 168-174.

Abramson R: Opioid treatment for patients in chronic noncancer pain. Am J Psychiatry. 2006; 163(7): 1299; author reply 300.




DOI: https://doi.org/10.5055/jom.2015.0273

Refbacks

  • There are currently no refbacks.