The impact of a multidisciplinary pain management model on sickle cell disease pain hospitalizations

Pediatric Blood and Cancer - Tập 56 Số 5 - Trang 789-793 - 2011
Amanda M. Brandow1, Steven J. Weisman1, Julie A. Panepinto1
1Medical College of Wisconsin/Children's Research Institute of the Children's Hospital of Wisconsin, Milwaukee, Wisconsin

Tóm tắt

AbstractBackgroundSickle cell disease (SCD) pain is acute or chronic, leads to school absenteeism, impaired health‐related quality of life and early mortality. Given that little is known about children with SCD and chronic pain, we (1) described characteristics of these children and (2) evaluated the impact of a multidisciplinary pain management model on health care utilization.ProcedureA retrospective cohort study of children with SCD evaluated and treated in our institution's multidisciplinary pain clinic between 1999 and 2008 was conducted. Referrals occur when children require chronic opioids and/or have frequent pain hospitalizations. Descriptive statistics evaluated patient characteristics and Wilcoxon‐Signed Rank evaluated change in median number of pain hospitalizations 1 year before and after referral.ResultsMedian age of 19 children identified was 15 years (IQR 11–17); significantly more were female (78.9% vs. 21.1%; P = 0.012). At time of referral, all patients reported taking opioids, 68.4% were taking hydroxyurea, half of those not on hydroxyurea started it (n = 3), none were chronically transfused and one initiated transfusions upon referral. Majority (89.5%) learned non‐pharmacologic pain management techniques. Median number of pain hospitalizations between the year before and after referral significantly decreased [5(IQR 3–6) to 1(IQR 0–4); P = 0.006]. To further delineate the pain clinic's effect, analysis was repeated after removing children initiating hydroxyurea/transfusions upon referral. The significant decrease in hospitalizations persisted [5(IQR 3–6) to 1(IQR 0–4; P = 0.022].Conclusions A multidisciplinary pain management model appears to have decreased SCD pain hospitalizations. Results of this retrospective study will need to be tested in a prospective randomized trial. Pediatr Blood Cancer 2011;56:789–793. © 2010 Wiley‐Liss, Inc.

Từ khóa


Tài liệu tham khảo

Hoffmann RG, 2005, Hematology: Basic Principles and Practice

10.1002/pbc.22222

10.1111/j.1365-2141.2008.07512.x

10.1002/pbc.20180

10.7326/0003-4819-148-2-200801150-00004

10.1111/j.1365-2141.2007.06592.x

10.1046/j.1365-2141.1999.01127.x

10.1056/NEJM199505183322001

BenjaminLJ JacoxDC OdesinaAK et al. Guideline for the management of acute and chronic pain in sickle cell disease [American Pain Society clinical practice guideline series No 1]. Glenview IL; 1999. Report.

The Management of Sickle Cell Disease. Volume Pub No.02=2117. NIH; 2002. p 161–165.

10.1016/0304-3959(92)90145-2

10.1093/jpepsy/26.3.163

10.1037/0278-6133.19.1.85

10.1093/jpepsy/jsh021

10.1023/A:1011960628192

10.1001/jama.2010.378

10.1089/jwh.2006.15.146

10.1111/j.1526-4637.2008.00558.x

10.1016/j.jpain.2008.12.001

10.1016/S0304-3959(98)00048-7

10.1053/gast.2002.36603

10.1016/j.pain.2007.10.014

10.1111/j.1365-2141.2005.05476.x

10.1302/0301-620X.73B6.1955442

10.1159/000046529

10.1016/j.ejpain.2006.12.009

10.1097/00002508-200112000-00004

1996, Guide to clinical preventive services: Report of the US Preventive Services Task Force

10.1093/jpepsy/16.5.643

10.1097/00002508-199706000-00005

10.1007/BF02883423

Thông tin
Thông tin xuất bản

Pediatric Blood and Cancer

Tập 56 Số 5

789-793

Thông tin tác giả