Depression, unemployment may increase pain frequency among people with sickle cell disease
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Key takeaways:
- Nearly half (47.8%) of patients reported frequent pain.
- Educational attainment and income had no significant association with increased pain episode frequency/severity.
Unemployment, depression, female sex and older age appeared associated with increased pain frequency among patients with sickle cell disease, according to study results published in JAMA Network Open.
The findings suggest depression screening is warranted for this patient population, researchers concluded.
Rationale and methodology
The current climate around pain management and opioid use has implications for individuals with sickle cell disease, Kelly M. Harris, PhD, CCC-SLP, assistant professor of occupational therapy and surgery at Washington University in St. Louis, told Healio.
“Pain is a hallmark of [sickle cell disease] and we felt it was important to both examine the relationship between depression, education, employment and pain in [the condition] and to consider how we address pain and complications of pain, especially among Black patients seeking care for sickle cell disease-related pain.”
In the cross-sectional analysis of data from eight sites included in the U.S. Sickle Cell Disease Implementation Consortium, researchers sought to examine the association between educational attainment, employment status and mental health with pain episode frequency and severity among 2,264 patients (mean age, 27.9 years; 56.2% women; 95.5% Black) with sickle cell disease.
Researchers pooled data from electronic medical records and disseminated a survey that inquired about patient demographics, mental health diagnosis and Adult Sickle Cell Quality of Life Measurement Information System pain scores.
They used multivariable regression to examine the associations of education, employment and mental health with the main outcomes.
Findings
About half of patients reported taking daily pain medication (47%) and/or hydroxyurea use (49.2%). Patients had a mean pain frequency score of 48.6 and severity t score of 50.3.
Among the patients in the study, 28% reported receipt of regular blood transfusions, 20% had a confirmed depression diagnosis, 79.8% reported severe pain and 47.8% reported more than four pain episodes within the previous year.
The majority (78%) of patients reported their highest level of education as a high school diploma or lower or some college, and 63.9% reported unemployment, with 54% reporting an average annual household income less than $25,000.
Researchers found that education and income did not appear associated with increased pain frequency or severity. Conversely, they observed an association between pain frequency and unemployment status (beta = 2.13; 95% CI, 0.99-3.23) and female sex (beta = 1.78; 95% CI, 0.8-2.76).
In addition, researchers observed an inverse association between age younger than 18 years and pain frequency (beta = 5.72; 95% CI, 7.72 to 3.72) and pain severity (beta = 5.1; 95% CI, 6.7 to 3.51). Depression appeared associated with increased pain frequency (beta = 2.18; 95% CI, 1.04-3.31) but not pain severity.
Results additionally showed an association between hydroxyurea use and increased pain severity (beta = 1.36; 95% CI, 0.47-2.24), and daily pain medication use appeared associated with both increased pain frequency (beta = 6.29; 95% CI, 5.28-7.31) and pain severity (beta = 2.87; 95% CI, 1.95-3.8).
Implications
“Although pain is both complex and multifaceted, we also know that racism, stigma and bias impact pain diagnosis and treatment for individuals with sickle cell disease,” Harris told Healio.
“When treating pain, we cannot only rely on medication,” Harris said. “It is important that providers consider the full experiences of patients and pursue holistic and comprehensive treatment approaches to reducing pain. Screening for depression should be a regular practice, particularly for patients experiencing frequent and/or severe pain.”
She said next steps include further examining the relationship between depression and sickle cell disease, as well as implementation of screening, assessments and the development of interventions to identify and address depression among this population.
For more information:
Kelly M. Harris, PhD, CCC-SLP, can be reached at kmharris@wustl.edu.
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