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Objective. To examine the relationship between pain, coping, and quality of life in adult patients with sickle cell disease (SCD) in the UK, and to assess the influence of these factors on the utilization of health services. Design, This cross-sectional study involved 96 adult patients with SCD attending hospitals in London. Method. Interview and questionnaire study involving standard measures of pain, health service utilization, coping responses (measured with the Coping Strategies Questionnaire -- revised for SCD), and quality of life (measured by the SF36). Data concerning clinical history, complications and haemoglobin levels were also collected. Results. The number and duration of painful sickle cell episodes in the past 12 months varied widely between patients. We found that 49.5% of accident and emergency visits and 45% of hospitalizations were of 10.4% (10) patients. Pain experience accounted for 12.3% of hospital and general practice service use, independently of age, sex, number of SCD complications and haemoglobin levels. Three higher order factors emerged from analysis of the coping strategies questionnaire, reflecting active behavioural and cognitive coping, affecting coping, and passive adherence (e.g. resting, taking fluids). Active coping was positively associated with the number of pain episodes, while passive adherence coping was related to pain intensity. Psychological coping was unrelated to health service utilization. Marked impairment on many dimensions of quality of life was apparent in the analyses of the SF36. Affective coping was associated with impaired quality of life independently of demographic and clinical variables. Conclusions, It is evident that siclde cell disease involves not only severe recurrent pain, but also other impairments in health-related quality of life. Psychological coping patterns... [ABSTRACT FROM AUTHOR]

Objectives: Sickle With Ibuprofen and Morphine (SWIM) trial was designed to assess whether co-administration of ibuprofen (a non-steroidal anti-inflammatory drug) resulted in a reduction of opioid consumption delivered by patient-controlled analgesia (PCA) for acute pain in sickle cell disease., Design: A randomised, placebo-controlled, double-blind trial., Setting: UK multicentre trial in acute hospital setting., Participants: Adults with sickle cell disease of any gender and phenotype aged 16 years and over., Interventions: Oral ibuprofen at a dose of 800 mg three times daily or placebo in addition to opioids (morphine or diamorphine) administered via PCA pump for up to 4 days., Main Outcome Measures: The primary outcome measure was opioid consumption over 4 days following randomisation., Results: The SWIM trial closed early because it failed to randomise to its target of 316 patients within a reasonable time., Conclusions: The key issues identified include the unanticipated length of time between informed consent and randomisation, difficulties in randomisation of patients in busy emergency departments, availability of trained staff at weekends and out of hours, fewer centres than expected using PCA routinely for sickle cell pain treatment, lack of research staff and support for participation, and the trial design. There are implications for future UK trials in sickle cell disease., Trial Registration Number: ISRCTN97241637, NCT00880373; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)