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From Bench to Bedside, CHORI Strives to Improve Pediatric Care
New Study Reveals Subtherapeutic Doses of Analgesics in Sickle Cell Treatment

Pain episodes are the most common of many complications associated with sickle cell disease, and they significantly impact a patient’s quality of life. In a new study in press at the Clinical Journal of Pain conducted at Children’s Hospital Research Center Oakland (CHRCO), CHORI researchers document the dramatically high intensity of pain experienced by children with sickle cell during vaso-occlusive episodes. The mean worst intensity score on the day of hospital admission for such children was 84.0 ± 9.9 on the 0 to 100 Oucher numeric rating scale.

“People have to recognize that pain can be a significant concern for children with sickle cell disease ,” says Marsha Treadwell, PhD, a clinical scientist in CHORI’s Center for Sickle Cell and Thalessemia and a psychologist at CHRCO who participated in the study, along with CHORI prinicpal investigator and CHRCO’s director of the Pediatric Sickle Cell Program, Lori Styles, MD.

The new study, which was lead by principal investigator Eufemia Jacob, PhD, RN, previously at CHRCO and now at Baylor College of Medicine, attempts to improve clinical outcomes and treatment in patients suffering vaso-occlusive pain episodes by improving evaluation of children admitted to CHO for pain.

“The American Pain Society created its first disease specific clinical practice guidelines, focused on sickle cell pain, relatively recently, in 1999,” explains Dr. Treadwell. “Pain measurement and treatment still remains widely variable.”

Pain experiences and treatment efficacy for patients with sickle cell disease have not been well-described either, highlighting both the timeliness and necessity of the study. The results of the study are significant in that they document the efficacy of treatments, and which treatments are most commonly used. In addition, the study demonstrates the utility of the Medication Quantification Scale (MQS) in the assessment of pain management.

“Professionals who deal with pain tend to go by their own judgment as opposed to adhering to clinical practice guidelines, which is recognized as a problem that needs to be remedied in general. We hope the study will improve both the assessment of pain quality, intensity, and effectiveness of treatments,” Dr. Treadwell says.

The most significant finding of the study, however, is that patients in general are receiving subtherapeutic levels of medication.

“We need to educate providers that pain management in sickle cell disease should be aggressive in the first two or three days of the hospital admission,” explains Dr. Treadwell. “In addition, another finding not in the current publication is that some of the children were under-dosed because they weren’t using medication even when they had access to it with patient controlled analgesia (PCA) devices. There are so many misconceptions about pain medicine that both providers and families tend to underutilize medications that are known to be effective.”

Hopefully, the breakthrough study will help change that. In a classic example of the way in which CHORI research results in bedside gains, CHO has already been utilizing the results of the study to try to improve assessment and follow-up in this patient population.

As Dr. Treadwell point out, “We want the pain treated aggressively, but we also want the pain assessed thoroughly as well, so that we can get a better handle on how well treatments are working.”

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Monday, May 16, 2011 11:33 PM

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