Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease.

Introduction/objective: Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED).
Methods: Retrospective review of electronic health records from a large, multicampus, pediatric SCD program.
Results: Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED.
Conclusion: Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
Competing Interests: CRM is the Executive Director of Food as Medicine Therapeutics, LLC; and is on the scientific advisory Board for Trility. CRM is the inventor or co-inventor of several UCSF-Benioff Children's Hospital Oakland patents/patent-pending applications that include nutritional supplements for autism/apraxia (receiving royalties); is an inventor or co-inventor of several Emory University School of Medicine patent application for nutritional supplements for autism, and coronaviruses, and kidney disease and is a consultant for Roche and CSL Behring, and an editor for the sickle cell disease-fever reference for UpToDate.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
(Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)