Abstract
BACKGROUND: Sickle 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. PROCEDURE: A 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. RESULTS: Median 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.