PAIN ASSESSMENT AND MANAGEMENT IN SICKLE CELL DISEASE

镰状细胞病的疼痛评估和治疗

• 批准号: 6032129
• 负责人: Carlton Dampier
• 金额: $ 2.5万
• 依托单位: MCP HAHNEMANN UNIVERSITY
• 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 1999-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6032129
• 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 非洲裔美国人的血管熟悉疼痛经历的特征 患有镰状细胞病（SCD）的儿童和青少年以确定 导致对镇痛疗法反应不佳的因素。我们的 假设是，对镇痛疗法的临床反应不佳是 多因素事件包括来自 疼痛经历的特征（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），从患者的心理 属性。此外，我们还将研究有助于 我们认为利用医院服务的必要性 患有SCD的患者和家庭治疗疼痛发作。我们的 假设是可以通过修改的应力来预测这种行为 心理调整模型。这些研究是较大计划的一部分 这决定了SCD中缺氧及其缺氧的患病率和病因 与血管 - 熟悉疼痛的关系，并检查 脂氧合酶代谢物在介导缺氧对 内皮细胞 - 红细胞相互作用。 该提案将是第一个专门表征的研究 门诊和医院治疗的疼痛发作的疼痛强度 在大量儿童和 SCD的青少年。更重要的是，这项研究将检查一些 这些患者疼痛经历的其他方面 先前研究了任何深度。我们将进行首次详细研究 静脉和口服吗啡和可待因的药代动力学 SCD患者。我们还将对 静脉注射吗啡通过表征剂量反应关系的关系 对CO2和PCA介导的镇痛作用的通气反应。最后，我们会的 检查患者的心理和心理社会属性 体验痛苦的发作，并表征那些预测的因素 心理调整，报告的疼痛严重程度或医院服务 利用率。 尽管这些研究中的每一个都可以孤立地进行，但 在同一患者人群中这些研究的结合， 预期的基础将产生大量的比较信息 将使我们能够评估一组全面的相对重要性 生物心理社会因素预测对镇痛的临床反应 疼痛发作的治疗，最常见和衰弱的疗法 SCD并发症。有了这些知识，我们将能够更好 减轻这些患者的痛苦和痛苦，并改善他们的 生活质量直到确定的反踢疗法成为一部分 我们针对SCD儿童和青少年的常规临床实践。