PAIN ASSESSMENT AND MANAGEMENT IN SICKLE CELL DISEASE

镰状细胞病的疼痛评估和治疗

• 批准号: 2228298
• 负责人: Carlton Dampier
• 金额: $ 25.32万
• 依托单位: ALLEGHENY UNIVERSITY OF HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-09-30 至 1998-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2228298
• 关键词: adolescence (12-20); analgesics; child (0-11); circadian rhythms; codeine; drug metabolism; hospital utilization; human subject; human therapy evaluation; hypoxia; kidney circulation; morphine; pain; patient care management; pharmacokinetics; psychological stressor; sickle cell anemia

This proposal will perform a comprehensive prospective assessment of the characteristics of the vaso-occlusive pain experience in African-American children and adolescents with Sickle Cell Disease (SCD) to determine the factors that contribute to a poor response to analgesic therapy. Our hypothesis is that poor clinical responses to analgesic therapy are a multi-factorial event that include potential contributions from characteristics of the pain experience (pain intensity), from the pharmacologic therapy (altered drug clearance, bioavailability, or altered dose-response relationship), and from the patient's psychological attributes. In addition, we will also examine factors that contribute to the perceived necessity for utilization of hospital-based services by our patients and families with SCD for treatment of painful episodes. Our hypothesis is that this behavior can be predicted by a modified stress- psychological adjustment model. These studies are part of larger program that is determining the prevalence and etiology of hypoxia in SCD and its relationship with vaso-occlusive pain, and examining the role of lipoxygenase metabolites in mediating the effects of hypoxia on endothelial cell - red cell interactions. This proposal will be the first study to specifically characterize the pain intensity of both outpatient and hospital-treated painful episodes with a prospective design in a large population of children and adolescents with SCD. More importantly, this study will examine several other facets of the pain experience in these patients that have not been previously studied in any depth. We will conduct the first detailed study of the pharmacokinetiCs of intravenous and oral morphine and codeine in patients with SCD. We will also conduct a study of the pharmacodynamics of intravenous morphine by characterizing the dose response relationship for ventilatory response to CO2 , and PCA-mediated analgesia. Finally, we will examine the psychological and psychosocial attributes of patients who experience painful episodes, and characterize those factors that predict psychological adjustment, reported pain severity, or hospital service utilization. While each one of these studies could be done in isolation, the combination of these studies in the same patient population, on a prospective basis, will yield a wealth of comparative information that will allow us to assess the relative importance of a comprehensive set of biopsychosocial factors which predict clinical response to analgesic therapy for painful episodes, the most frequent and debilitating complication of SCD. With this knowledge, we will be better able to alleviate the pain and suffering of these patients, and improve their quality of life until definitive anti-sickling therapy becomes a part of our routine clinical practice for children and adolescents with SCD.

该提案将对以下方面进行全面的前瞻性评估： 非裔美国人血管闭塞性疼痛经历的特征 患有镰状细胞病 (SCD) 的儿童和青少年，以确定 导致镇痛治疗反应不佳的因素。我们的 假设是对镇痛治疗的临床反应不佳是 多因素事件，包括来自以下方面的潜在贡献 疼痛体验的特征（疼痛强度） 药物治疗（改变药物清除率、生物利用度或改变 剂量-反应关系）以及患者的心理 属性。此外，我们还将研究影响因素 我们认为利用医院服务的必要性 患有 SCD 的患者和家庭用于治疗疼痛发作。我们的 假设这种行为可以通过修改后的压力来预测 心理调节模型。这些研究是更大计划的一部分 确定 SCD 中缺氧的患病率和病因及其 与血管闭塞性疼痛的关系，并检查其作用 脂氧合酶代谢物介导缺氧的影响 内皮细胞-红细胞相互作用。 该提案将是第一项专门描述 门诊和医院治疗的疼痛发作的疼痛强度 针对大量儿童进行前瞻性设计， 患有 SCD 的青少年。更重要的是，这项研究将检验几个 这些患者疼痛经历的其他方面尚未被了解 以前曾进行过任何深入的研究。我们将进行第一次详细研究 静脉注射和口服吗啡和可待因的药代动力学 患有 SCD 的患者。我们还将进行药效学研究 通过表征剂量反应关系来静脉注射吗啡 对 CO2 的通气反应和 PCA 介导的镇痛。最后，我们将 检查患者的心理和社会心理属性 经历痛苦的​​经历，并描述那些预测的因素 心理调整、报告的疼痛严重程度或医院服务 利用率。 虽然这些研究中的每一项都可以单独进行， 将这些研究结合在同一患者群体中， 前瞻性的基础上，将产生大量的比较信息 将使我们能够评估一套全面的相对重要性 预测镇痛临床反应的生物心理社会因素 治疗疼痛发作，最常见和使人衰弱的情况 SCD 的并发症。有了这些知识，我们就能更好地 减轻这些患者的痛苦，改善他们的生活质量 生活质量，直到明确的抗镰状细胞治疗成为 我们针对患有 SCD 的儿童和青少年的常规临床实践。