Breaking News
February 21, 2019 - Gaming system helps with autism diagnosis
February 21, 2019 - Heart Disease: Six Things Women Should Know
February 21, 2019 - More States Say Doctors Must Offer Overdose Reversal Drug Along With Opioids
February 21, 2019 - Researchers explore case studies focused on industries that kill more people than employed
February 21, 2019 - Intense exercise, fasting and hormones can enhance waste-protein removal, study shows
February 21, 2019 - Scientists can monitor brain activity to predict epileptic seizures few minutes in advance
February 21, 2019 - Study quantifies hepatic and intestinal mRNA expression of Ugt isoforms in rats
February 21, 2019 - ‘Apple-Shaped’ Body? ‘Pear-Shaped’? Your Genes May Tell
February 21, 2019 - Can we repair the brain? The promise of stem cell technologies for treating Parkinson’s disease
February 21, 2019 - Trump Plan To Beat HIV Hits Rough Road In Rural America
February 21, 2019 - PENTAX Medical introduces new electrosurgical and argon plasma coagulation platforms
February 21, 2019 - Trump plan to beat HIV hits rough road in rural America
February 21, 2019 - Eating blueberries every day could help decrease blood pressure
February 21, 2019 - ‘No Second Chances’ report calls for new measures to combat cardiovascular disease in Australia
February 21, 2019 - Mayo clinic researchers discuss local case studies of leprosy
February 21, 2019 - Scientists demonstrate key role of salt in allergic immune reactions
February 21, 2019 - Experts propose revising the criteria for diagnosis of Parkinson’s disease
February 21, 2019 - The med student and the machine
February 21, 2019 - Hey, Hey! Ho, Ho! Is Striking For School Nurses The Way To Go?
February 21, 2019 - Latest research encourages children to move out and learn through physical activity
February 21, 2019 - Proper oral hygiene and regular visits to dentist can promote heart health
February 21, 2019 - New, versatile technique for remote control of transplanted cells in Parkinson’s
February 21, 2019 - Why melanoma tumors in the brain may be worse?
February 21, 2019 - New project aims to improve lung disease care in Appalachia
February 21, 2019 - Drug increases melanin production in some people with albinism
February 21, 2019 - Over 1 in 3 adults miss the mark on protein, finds study
February 21, 2019 - CymaBay Therapeutics Announces Seladelpar Granted Breakthrough Therapy Designation by the FDA for the Treatment of Primary Biliary Cholangitis
February 21, 2019 - A correlation between obesity and income has only developed in the past 30 years
February 21, 2019 - Baby, then work: An effort to help resident-parents in emergency medicine
February 21, 2019 - Heavy cigarette smoking could damage vision, say researchers
February 21, 2019 - Some drug combinations may be more effective than others for schizophrenic patients
February 21, 2019 - Combination of common antibiotics can eliminate multi-drug resistant E. coli
February 21, 2019 - Number of calls to U.S. Poison Control regarding kratom exposure increased
February 21, 2019 - New computational tool searches for factors that cause specific diseases
February 21, 2019 - New method to assess effectiveness of psychotherapies for social anxiety disorder
February 21, 2019 - New technology measures hormones that influence reproductive health efficiently
February 21, 2019 - Bat influenza viruses could potentially attack the cells of humans and livestock
February 21, 2019 - Immunotherapeutic antibody therapy to kill cancer has now progressed to patient testing
February 21, 2019 - Johns Hopkins scientists find new compound that may prevent reperfusion injury
February 21, 2019 - Researchers develop new way to deliver treatment for cartilage regeneration
February 21, 2019 - Study sheds new light on left ventricular dysfunction in ischemic heart disease
February 21, 2019 - New technique could expedite cancer diagnosis, lead to better patient outcomes
February 21, 2019 - New map of infant brain may aid early diagnosis of autism
February 21, 2019 - Human consciousness depends on the brain’s ability to maintain dynamics of neural activity
February 21, 2019 - Harmony Biosciences Announces File Acceptance Of Its New Drug Application For Pitolisant
February 21, 2019 - Medications could fill treatment gap for adolescents with obesity
February 21, 2019 - New antibiotics are desperately needed: Machine learning could help | News Center
February 21, 2019 - Researchers develop new computer game for dementia carers
February 21, 2019 - University of Dundee partners with Takeda to develop new treatments for tau pathology
February 21, 2019 - Influenza vaccine may be less effective in elderly patients, finds study
February 21, 2019 - Researchers explain why T cells lose their protective ability in inflamed tissues
February 21, 2019 - New optimization method rapidly analyzes nanomedicines for cancer treatment
February 21, 2019 - Viruses in the intestinal tracts can lead to islet autoimmunity and Type 1 diabetes
February 21, 2019 - Link between dietary fatty acid intake and hypertension found to be influenced by diabetes status
February 21, 2019 - FDA Approves Esperoct (turoctocog alfa pegol, N8-GP) for Hemophilia A
February 21, 2019 - ‘Boy erased’—why conversion therapies and ex-gay ministries should be outlawed
February 21, 2019 - Titia de Lange to give annual McCormick Lecture on March 8 | News Center
February 21, 2019 - Study reveals how helper T cells support memory cells to function optimally
February 21, 2019 - Autistic children with co-occurring ADHD have greater adaptive behavior impairments
February 21, 2019 - Elevated levels of key cellular process implicated in intestinal inflammation and IBD
February 20, 2019 - Over Half of Hip Replacements Expected to Last 25 Years
February 20, 2019 - Microscopic eye movements affect how we see contrast
February 20, 2019 - Computer vs. patient: Fighting for residents’ attention | News Center
February 20, 2019 - New “Smart Drug” Shows Promise for Metastatic Triple-Negative Breast Cancer
February 20, 2019 - Researchers develop large-scale window material for high-efficiency PM2.5 capture
February 20, 2019 - Widespread confusion among consumers on food date labels lead to unnecessary discards
February 20, 2019 - Researchers unlock plant’s secret of producing specialized metabolites
February 20, 2019 - Newly released national framework identifies obstacles to improving EMS systems
February 20, 2019 - Exercise can shift human body clock depending on time when people work out
February 20, 2019 - Female adolescent blood donors more likely to have iron deficiency and related anemia
February 20, 2019 - Rubicon level linked to inhibition of autophagic process
February 20, 2019 - Researchers find potential therapeutic strategy to treat Alzheimer’s
February 20, 2019 - New forms of older anti-cancer agent appear to enhance immune response to fight melanoma
February 20, 2019 - Health Tip: Eat Less Saturated Fat
February 20, 2019 - Sleeping in contact lenses puts you at risk of dangerous infection
February 20, 2019 - “We should study that!”: How a nurse-scientist found her passion
February 20, 2019 - Cervical microbiome may influence HPV infection more than previously thought
February 20, 2019 - Sausage mislabeling in Canada is down, new study finds
February 20, 2019 - Study shows blood pressure benefits of morning exercise for older overweight/obese adults
February 20, 2019 - New screening method could catch organ rejection much earlier without a biopsy needle
Johns Hopkins researchers report challenges in treating severe crisis pain of sickle cell disease

Johns Hopkins researchers report challenges in treating severe crisis pain of sickle cell disease

image_pdfDownload PDFimage_print

Findings underscore need to find alternatives and supplements to opioids, researchers say

In a study tracking the severe crisis pain of sickle cell disease and its management in 73 adults over a period of a year, Johns Hopkins researchers found that even among those on high doses of daily at-home opioids, a persistent subset was more likely to seek emergency hospital care for crisis pain and was less likely to have the pain controlled by intensive treatment.

The researchers say their findings, described in the September issue of the American Journal of Hematology, underscore the persistent difficulties, poor patient outcomes and high costs associated with assessing and addressing the 10 to 20 percent of patients with sickle cell who are the sickest and have the most pain.

“Although progress has been made in managing the pain crises of many with sickle cell, there remains a group of sicker patients who seek hospital care with greater than typical frequency and whose pain is not being treated effectively,” says C. Patrick Carroll, M.D., director of psychiatric services for the Johns Hopkins Sickle Cell Center for Adults and assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. “We want to focus our efforts on figuring out how to deliver high value care to our sickest patients.”

Sickle cell disease is the most common inherited blood disorder diagnosed in the United States, affecting an estimated 100,000 people, most of them African-Americans. In addition, about one in 13 Americans of African descent carry one copy of the gene that causes sickle cell disease, and have “sickle cell trait.” People who inherit two copies have sickle cell anemia, the disorder’s most common form. The disorder is marked by the characteristic “sickled” or crescent-shape red blood cells that can get stuck in small blood vessels feeding bones, creating recurrent bouts of crippling pain that require opioids and sometimes urgent hospitalization. Beyond the disabling toll on patients, the disease accounts for a significant amount of health care costs — an estimated $500 million per year. About 10-20 percent of people with sickle cell account for more than 50 percent of the costs, Carroll says, reflecting the reality of patients with sickle cell whose pain episodes are more frequent and more intense than usual.

“The most clinically interesting finding but also the most puzzling was the extent to which higher opioid doses — both at home and during acute visits — were tied to poorer outcomes and more complications,” says Carroll. “There is the conundrum that despite more aggressive treatment, a subset of people didn’t get as much benefit.”

He says growing tolerance to opioids may be one explanation, along with emergency room physicians who don’t know a patient’s history to quickly provide adequate pain medicines when pain crises occur, which may require higher opioid doses than are safe for a typical patient. Care is fragmented, Carroll says, and because there are no objective measures of pain, some physicians are reluctant to prescribe higher doses of opioids.

In their study that documented the source of higher-than-typical infusion center visits, the researchers looked at data from 73 patients seen at the Johns Hopkins Sickle Cell Center for Adults. Patients were an average age of 34, and 62 percent were women. Participants all underwent assessment on a standard Pain Anxiety Symptoms Scale, and researchers collected information on patients’ socioeconomic status, insurance coverage and education level. The researchers relied on medical records to document admission to the Sickle Cell Infusion Center, where patients get treated for crisis pain. Opioid doses were converted to a standard measurement of “morphine equivalents” so drug quantity could be easily compared among participants.

With those data, the researchers classified 23 people as “typical” users of the infusion center (less than five visits over a year). Another 23 people were considered “high” users of the infusion center (five visits or more). The remaining 27 people had no visits in a calendar year.

Typical users of the infusion center were on an average of about 26 morphine equivalents of opioids daily at home, compared to high-users who were on about 66 morphine equivalents of opioid medication daily.

Although the typical users had on average the same initial crisis pain rating as the high-users (8.5 versus 8.4 on a scale of 10), the typical users of infusion center care reported an average reduction of 3.8 pain points after treatment with opioids intravenously, putting their pain level around 5, compared to the high-users of infusion center care who only reported a drop of an average of 1.6 pain points, putting them at around 7 for reported pain after treatment. Pain improvement was twice as great for typical infusion center users, yet they received less than half the opioid dosage (~26 milligrams) during the emergency visits than those high users of the infusion center (~66 milligrams).

Because it’s a challenge to manage pain effectively without prescribing potentially unsafe amounts of opioids, what’s clear, Carroll says, is the need to develop more nonopioid pain relievers that don’t increase risks of tolerance and overdose.

One of the biggest drivers of cost and ineffective treatment of people with sickle cell, he says, is that in many cases the health care team dealing with people in an emergency setting during crisis isn’t the same providers who help the patient manage day-to-day care. “This typically means that emergency care providers don’t reliably know medication dosages and treatment plans in place for that person,” Carroll says.

There is a great need, he adds, for sickle cell disease clinical centers that manage both day-to-day and 24/7 emergency care, such as those with the integrated approach used by the Johns Hopkins Sickle Cell Infusion Center that can help bridge the care gap and keep treatment consistent.

Sickle cell disease is most common in people with ancestry near the equator, such as African, Indian, Asian, Middle Eastern and Mediterranean, or places where malaria is common. Sickle cell disease can damage the internal organs and, on average, the life spans of people with the disease are 30 years shorter than in the general population.

Source:

http://www.hopkinsmedicine.org/news/newsroom/news-releases/study-affirms-challenges-in-managing-severe-pain-of-sickle-cell-disease

Tagged with:

About author

Related Articles