scholarly journals Pediatric residents’ perceived barriers to opioid use in sickle cell disease pain management

2018 ◽  
Vol 66 (2) ◽  
pp. e27535 ◽  
Author(s):  
Amber Fearon ◽  
Anne Marsh ◽  
Jennifer Kim ◽  
Marsha Treadwell
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Perceived Barriers ◽  
Cell Disease ◽  
Opioid Use ◽  
Pediatric Residents

scholarly journals L-Glutamine Decreases Opioid Use in Individuals with Sickle Cell Disease and Chronic Pain: A Case Series

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4849-4849
Author(s):  
Samuel Wilson ◽  
Frances Wright ◽  
Marcus A. Carden
Keyword(s):  
Chronic Pain ◽  
North Carolina ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Over Time

Background: Sickle cell disease (SCD) is the most common inherited blood disorder in the United States (US), affecting approximately 100,000 individuals in the country who are primarily of African descent. One of the most prevalent complications of SCD is pain as a result of episodic vaso-occlusive crises. Over time, many individuals with SCD develop chronic pain and opioid dependence for pain management. L-glutamine (EndariTM) was approved by the US Food and Drug Administration in 2017 for patients 5 years-old and older to reduce complications from SCD after reviewing a phase-III placebo-controlled trial. In this study, L-glutamine led to a reduction in median number of pain crises and increased time to first pain crisis when compared to placebo (Niihara et al, NEJM, 2018). However, the impact of L-glutamine on opioid use over time remains unknown. In this study, we evaluated the effect on opioid use in individuals who were started on L-glutamine for worsening SCD related pain. Methods: After institutional review board approval, we retrospectively reviewed the electronic medical record (EMR) of individuals with SCD followed at the University of North Carolina Pediatric and Adult Sickle Cell clinics prescribed L-glutamine in 2018-2019 for worsening acute and chronic SCD-related pain. The North Carolina state controlled substance reporting system, an online clinical tool which collects information on dispensed controlled substance prescriptions to patients that is freely available to prescribers, was also reviewed for filled opioid prescriptions (and milligram morphine equivalents - MME) for each patient. Data, including health care utilization (e.g. hospitalizations and emergence room (ER) visits) and hemoglobin levels for each patient were also evaluated in the EMR for the four months preceding and the four months after L-glutamine was started to determine if changes were sustained. Results: We identified four female patients (ages ranging from 9 to 24 years-old) with SS genotype and chronic pain with acute exacerbations who had significant opioid prescription reduction after starting L-glutamine. Three individuals were taking the maximum tolerated dosing of hydroxyurea and experiencing escalating pain crises prior to initiation of L-glutamine. One patient was intolerant of hydroxyurea and was on a chronic transfusion program for chronic pain management when she was started on L-glutamine for worsening chronic pain. All patients, or caregivers, reported a reduction in acute on chronic pain after initiating L-glutamine. Each patient had a reduction in 4-month total opioid prescription use (in MME) after starting L-glutamine, ranging from a 21% reduction to 100% reduction (Figure 1). Heath care utilization significantly decreased in 1 patient after starting L-glutamine, with 3 ER visits and 2 hospitalizations in the pre-treatment period and no ER visits or hospitalizations in the post-treatment period. There was no difference in the average hemoglobin levels pre-and-post L-glutamine initiation among the patients (9.8g/dL vs. 9.7g/dL). Discussion: L-glutamine appears to have some benefit in reducing pain and opioid use, as well as healthcare utilization, in a subset of patients with SCD and chronic pain. Although we evaluated a small number of patients, all individuals (or caregivers) reported decreased pain very soon after starting L-glutamine. One patient stopped opioid use altogether in the time period evaluated. Future studies should investigate if effectiveness of L-glutamine may be based on unique red cell metabolic profiles, SCD genotype, or timing of drug initiation in these and similar patients. Future investigations will also determine long-term tolerability of L-glutamine and if the reduction in opioid use is sustained for longer periods among these patients and other responders. Disclosures Carden: GBT: Honoraria; NIH: Research Funding.

scholarly journals The Role of Cognitive Behavioral Therapy in Opioid Use Reduction in Pediatric Sickle Cell Disease: Protocol for a Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ashaunta T Anderson ◽  
Nhu Tran ◽  
Kathryn Smith ◽  
Lorraine I Kelley-Quon
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Cognitive Behavioral Therapy ◽  
Sickle Cell ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Cell Disease ◽  
Opioid Use ◽  
Eligibility Criteria

BACKGROUND Sickle cell disease (SCD) is a genetic disorder of red blood cells that results in acute and chronic health problems, including painful syndromes. Opioid analgesia is the mainstay of moderate to severe pain management in SCD, although adjunctive psychosocial approaches such as cognitive behavioral therapy (CBT) are increasingly incorporated. CBT has been used in populations of various ages to address a wide range of issues, such as mood disorders and chronic pain. It is unclear if effective CBT reduces the use of opioids to manage pain in pediatric SCD. OBJECTIVE The aim of this study is to evaluate the association between CBT and decreased opioid use in children with SCD. METHODS In this systematic review protocol, we describe our approach to applying predetermined eligibility criteria to searches of PubMed (including Medline), Embase, Cochrane, Web of Science, and PsycINFO databases, as well as Google Scholar and grey literature. In particular, we will use keywords to search for English-language studies of individuals with SCD aged 21 years old and younger published before November 2018. Keywords will allow us to assess for the primary outcome—total use of opioid medications—and the secondary outcomes—pain intensity and emotional functioning—during pain management using a combined opioid and CBT approach, opioids alone, or CBT alone. The review team will use standardized abstraction forms to review articles at the title, abstract, and full-text levels. Finally, reviewers will assess the risk for bias, quality of evidence, and adequacy of data for quantitative versus qualitative synthesis. If meta-analysis is deemed inappropriate, a narrative review will be conducted. RESULTS We will report a summary of findings across studies that meet eligibility criteria to compare the extent to which adjunctive CBT is associated with decreased opioid use among children with SCD. CONCLUSIONS This systematic review will present the current state of the evidence on CBT and opioid use in pediatric SCD, which may inform clinical practice and health policy to support optimized pain management. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/13211

Effects Of GMI 1070, a Pan-Selectin Inhibitor, On Pain Intensity and Opioid Utilization In Sickle Cell Disease

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 775-775 ◽  
Author(s):  
Laura M. De Castro ◽  
Ted Wun ◽  
Sophie Lanzkron ◽  
Wally R. Smith ◽  
Kathryn L. Hassell ◽  
...  
Keyword(s):  
Placebo Group ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Pain Intensity ◽  
Sickle Cell ◽  
Research Funding ◽  
Study Drug ◽  
Cell Disease ◽  
Opioid Use ◽  
Vas Scores

Abstract Background Management of acute, painful vaso-occlusive crisis (VOC), the hallmark of sickle cell disease (SCD), continues to be limited to symptomatic relief with oral and/or intravenous (IV) opioids. The efficacy of GMI 1070, a novel pan-selectin inhibitor, was recently evaluated in SCD patients hospitalized for VOC. We report in-depth analysis of pain intensity variation, duration and extent of pain management and other pain-related responses in this study. Methods A multi-center, randomized, double-blind, placebo-controlled Phase 2 trial of multiple IV doses of GMI 1070 in subjects (12-60 yrs) hospitalized for VOC was conducted. A loading dose to achieve steady state drug level was followed by q12 hours (h) maintenance doses. Study drug dose was doubled per protocol after interim PK analysis. Pain intensity was assessed by a 10 cm Visual Analog Scale (VAS); sustained reduction of 1.5 cm or higher and transition to oral analgesics were included in the composite primary endpoint “time to resolution of VOC,” as were readiness for discharge and time to discharge. Opioid utilization was recorded, converted to Morphine Equivalent Units (MEU) based on standard guidelines, and normalized by body weight. Patient controlled analgesia (PCA), oral analgesic and other therapies were not mandated and reflected institutional and individual practices. Comparisons were made between pooled GMI 1070 (low and high dose) and placebo. Analysis of covariance (ANCOVA), adjusting for sex and age, was used to determine differences between groups. Kaplan-Meier (KM) analysis (log rank test) was performed to compare time to event between treatment groups. Results Mean (SD; range) VAS at presentation to ED for all subjects was 8.6 (1.6; 5-10) and decreased before study drug start (baseline) to 6.7 (2.3; 0.8-10), reflecting initial pain management. Mean VAS scores at presentation and at baseline were not different between GMI 1070 and placebo groups. However, VAS changes from baseline by elapsed hours since drug start and probability of sustained 1.5 cm reduction in VAS over time showed that patients receiving GMI 1070 had earlier changes than those in the placebo group, starting at 48 h, (p=0.43, Fig 1a). Similarly, pain intensity reduction was greater by ∼1.5 cm and more rapid within the first 100 h of study treatment for those on GMI 1070 (p=0.58, Fig 1b). In subjects still hospitalized 48 h after study drug initiation, the GMI 1070 group with concomitant hydroxyurea (HU) had the lowest VAS scores. Mean (SD; range) VAS at discharge was 4.03 (2.97; 0-10) in the placebo group and 3.02 (2.75; 0-9.8) in the GMI 1070 group. ANCOVA analysis showed that time to resolution of VOC and time to discharge were shorter in the GMI 1070 group compared to placebo, independent of HU use. Not only was mean [SE] time to transition from parenteral to oral pain medications reduced in the GMI 1070 group vs placebo (108.6 [20.8] vs 155.6 [23.8] h; p=0.14), but active drug exposure was associated with a significant reduction in initial (24 h) and cumulative (during hospitalization) opioid use (oral, IV or both routes) as compared to placebo (Table). Opioid use decreased compared to baseline in the GMI 1070 group within 4 h, while the placebo group did not go below baseline rate until 96h. Duration of IV or oral non-steroidal anti-inflammatory drug (NSAID) use was also lower in the GMI 1070 group vs placebo. Conclusion GMI 1070 therapy was associated with a significant reduction in IV opioid requirement and overall pain medication utilization in subjects hospitalized for SCD VOC. There was also an early decrease in pain intensity as measured by VAS, although this did not reach statistical significance. These effects were independent of HU use and suggest that GMI 1070 has a rapid onset of action and should be investigated for initial and early treatment of VOC in SCD, with the goal of reducing pain intensity and duration, as well as need for opioid therapy. Disclosures: De Castro: Novella Clinical: Consultancy; GlycoMimetics, Inc.: Research Funding. Wun:Emmaus, Inc.: Clinical Adjudication Committee Other; Pfizer, Inc.: Consultancy; GlycoMimetics: Research Funding. Lanzkron:GlycoMimetics, Inc.: Research Funding. Smith:GlycoMimetics, Inc.: Research Funding. Hassell:Glycomimetics, Inc: Research Funding. Kutlar:GlycoMimetics, Inc: Research Funding. Smith-Whitley:GlycoMimetics, Inc: Research Funding. Rhee:GlycoMimetics, Inc.: Research Funding; Rho, Inc.: Employment. Telen:GlycoMimetics, Inc.: Research Funding; Dilaforette, NA: Research Funding; Pfizer, Inc.: Consultancy. Thackray:GlycoMimetics, Inc.: Employment, Equity Ownership.

Parent Perspectives on Pain Management, Coping, and Family Functioning in Pediatric Sickle Cell Disease

2007 ◽  
Vol 46 (4) ◽  
pp. 311-319 ◽  
Author(s):  
Monica J. Mitchell ◽  
Kathleen Lemanek ◽  
Tonya M. Palermo ◽  
Lori E. Crosby ◽  
Alisha Nichols ◽  
...  
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Family Functioning ◽  
Sickle Cell ◽  
Parent Perspectives ◽  
Cell Disease ◽  
Pediatric Sickle Cell Disease

scholarly journals Sickle cell disease pain management and the medical home

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 433-438 ◽  
Author(s):  
Jean L. Raphael ◽  
Suzette O. Oyeku
Keyword(s):  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Home ◽  
Cost Effective ◽  
Cell Disease ◽  
Patient Centered ◽  
Centered Care ◽  
The Individual ◽  
Effective Models

Pain is the most common cause for hospitalization and acute morbidity in sickle cell disease (SCD). The consequences of SCD-related pain are substantial, affecting both the individual and the health care system. The emergence of the patient-centered medical home (PCMH) provides new opportunities to align efforts to improve SCD management with innovative and potentially cost-effective models of patient-centered care. The Department of Health and Human Services has designated SCD as a priority area with emphasis on creating PCMHs for affected patients. The question for patients, clinicians, scientists, and policy-makers is how the PCMH can be designed to address pain, the hallmark feature of SCD. This article provides a framework of pain management within the PCMH model. We present an overview of pain and pain management in SCD, gaps in pain management, and current care models used by patients and discuss core PCMH concepts and multidisciplinary team–based PCMH care strategies for SCD pain management.

scholarly journals Hospitalization Events among Children and Adolescents with Sickle Cell Disease in Basra, Iraq

Anemia ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Zeina A. Salman ◽  
Meaad K. Hassan
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Readmission Rate ◽  
Length Of Hospital Stay ◽  
Acute Chest Syndrome ◽  
Cell Disease ◽  
Opioid Use ◽  
Asthma Symptoms ◽  
The Mean ◽  
High Readmission Rate

Objectives. Despite improvements in the management of sickle cell disease (SCD), many patients still experience disease-related complications requiring hospitalizations. The objectives of this study were to identify causes of hospitalization among these patients and factors associated with the length of hospital stay (LOS) and readmission.Methods. Data from 160 patients (<14 years old) with SCD who were admitted to the Basra Maternity and Children’s Hospital from the first of January 2012 through July 2012 were analyzed.Results. The main causes of hospitalization were acute painful crises (73.84%), infections (9.28%), acute chest syndrome (8.02%), and acute splenic sequestration crisis (6.32%). The mean LOS was4.34±2.85days. The LOS for patients on hydroxyurea (3.41±2.64days) was shorter than that for patients who were not (4.59±2.86days),P<0.05. The readmission rate (23.1%) was significantly higher among patients with frequent hospitalizations in the previous year (OR 9.352, 95% CI 2.011–43.49), asthma symptoms (OR 4.225, 95% CI 1.125–15.862), and opioid use (OR 6.588, 95% CI 1.104–30.336). Patients on hydroxyurea were less likely to be readmitted (OR 0.082, 95% CI 0.10–0.663).Conclusions. There is a relatively high readmission rate among patients with SCD in Basra. The use of hydroxyurea significantly decreases the LOS and readmission rate.

Optimizing Pain Management For Children With Sickle Cell Disease Vaso-occlusive Crisis In The Pediatric Emergency Department

2021 ◽  
Author(s):  
Wilson Andres Vasconez ◽  
Claudia Aguilar-Velez ◽  
Cristina Matheus ◽  
Hector Chavez ◽  
Roxana Middleton-Garcia ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Cell Disease

Age-related prescription medication utilization for the management of sickle cell disease among Texas Medicaid patients

2021 ◽  
Vol 17 (4) ◽  
pp. 301-310
Author(s):  
Nidhi Shukla, MS, MBA ◽  
Jamie C. Barner, PhD, FAACP, FAPhA ◽  
Kenneth A. Lawson, PhD, FAPhA ◽  
Karen L. Rascati, PhD
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Age Groups ◽  
Dual Therapy ◽  
Cell Disease ◽  
Opioid Use ◽  
Medication Utilization ◽  
Age Related ◽  
Nonopioid Analgesics ◽  
Chi Square Analysis

Introduction: Sickle cell disease (SCD) is associated with recurrent complications and healthcare burden. Although SCD management guidelines differ based on age groups, little is known regarding actual utilization of preventative (hydroxyurea) and palliative therapies (opioid and nonopioid analgesics) to manage complications. This study assessed whether there were age-related differences in SCD index therapy type and SCD-related medication utilization.Design and patients: Texas Medicaid prescription claims from September 1, 2011 to August 31, 2016 were retrospectively analyzed for SCD patients aged 2-63 years who received one or more SCD-related medications (hydroxyurea, opioid, or nonopioid analgesics).Outcome measures: The primary outcomes were SCD index drug type and medication utilization: hydroxyurea adherence, and days’ supply of opioid, and nonopioid analgesics. Chi-square, analysis of variance, and Kruskal–Wallis tests were used.Results: Index therapy percentages for included patients (N = 2,339) were the following: opioids (45.7 percent), nonopioids (36.6 percent), dual therapy-opioids and nonopioids (11.2 percent), and hydroxyurea (6.5 percent), and they differed by age-groups (χ2 = 243.0, p 0.0001). Hydroxyurea as index therapy was higher among children (2-12:9.1 percent) compared to adults (26-40:3.7 percent; 41-63:2.9 percent). Opioids as index therapy were higher among adults (18-25:48.0 percent; 26-40:54.9 percent; 41-63:65.2 percent) compared to children (2-12:36.6 percent). Mean hydroxyurea adherence was higher (p 0.0001) for younger ages, and opioid days’ supply was higher for older ages.Conclusions: Texas Medicaid SCD patients had low hydroxyurea utilization and adherence across all age groups. Interventions to increase the use of hydroxyurea and newer preventative therapies could result in better management of SCDrelated complications and reduce the frequency of pain crises, which may reduce the need for opioid use.

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