Abstract
The impact of pain early in life is a salient issue for sickle cell disease (SCD),
a genetic condition characterized by painful vaso-occlusive episodes (VOEs) that can
begin in the first year of life and persist into adulthood. This study examined the
effects of age and pain history (age of onset and frequency of recent VOEs) on acute
procedural pain in children with SCD. Endothelin-1, a vaso-active peptide released
during VOEs and acute tissue injury, and its precursor, Big Endothelin, were explored
as markers of pain sensitization and vaso-occlusion. Sixty-one children with SCD (ages
2 to 18) underwent venipuncture at routine health visits. Procedural pain was assessed
via child and caregiver reports and observational distress. Pain history was assessed
using retrospective chart review. Three primary results were found: 1) younger age
was associated with greater procedural pain across pain outcomes; 2) higher frequency
of VOEs was associated with greater procedural pain based on observational distress
(regardless of age); and 3) age was found to moderate the relationship between VOEs
and procedural pain for child-reported pain and observational distress for children
5 years of age and older. Associations between the endothelin variables and pain prior
to venipuncture were also observed.
Perspective
For children with SCD, the child's age and recent pain history should be considered
in procedural pain management. The endothelin system may be involved in preprocedure
pain, but additional research is needed to understand the role of endothelins in pain
sensitization.
Key words
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Article info
Publication history
Published online: May 28, 2012
Accepted:
April 3,
2012
Received in revised form:
March 9,
2012
Received:
February 4,
2012
Footnotes
Supported by the following programs: USC School of Medicine Translational Research Grant (S.M.S., C.W.R.); USC School of Medicine Department of Pharmacology, Physiology, and Neuroscience Seed Grant for Translational Research (S.M.S., J.C.S.); the Pfizer Fellowship in Health Disparities (C.B.M.); the National Institutes of Health (RO1 DA023593 to S.M.S.); and the National Institutes of Health, National Institute of General Medical Sciences (T32 GM081740 to A.M.S.).
No conflicts of interest are declared by the authors.
Identification
Copyright
© 2012 American Pain Society. Published by Elsevier Inc. All rights reserved.
