A Comparison of Two Pain Assessment Tools, the Adolescent Pediatric Pain Tool and PAINReportIt and Use of the Composite Pain Index in Sickle Cell Disease

Pain is a common acute and chronic complication of sickle cell disease (SCD) in pediatric patients. However there are very few pain assessment tools that can assess patients for the multidimensional components of pain. The Adolescent Pediatric Pain Tool (APPT) is a validated, self-administered paper and pencil pain assessment tool validated in children and adolescents. The McGill Pain questionnaire (MPQ) is a pain assessment tool validated in adolescents and adults. PAINReportIt (PR) is a self-administered, computerized version of the MPQ. The APPT and PR can each be administered in a single outpatient clinic visit. The Composite Pain Index (CPI), a multidimensional representation of pain, can be calculated with both the APPT and PR. It is calculated by summing the individual standardized-scores for each of the four pain dimensions: (1) number of sites, (2) intensity, (3) total pain rating index, and (4) the pain pattern score. The use of these tools can present pain as the all-important 5th vital sign and may assist providers in the treatment of the multiple components of pain in pediatric SCD. The aim of this study was to compare the use of two pain assessment tools, the APPT and PR in pediatric SCD patients with respect to the composite pain index and the multiple dimensions of pain.

Patients with the following genotypes were eligible for this study: Hb SS, Hb SC, Hb Sb⁰-thalassemia, and Hb Sb⁺-thalassemia. Patients who were 14 years and older were eligible to complete both tools on a single, outpatient visit to a comprehensive SCD clinic. The number of pain sites, intensity and the CPI were analyzed with descriptive, correlation, and independent t-test statistics.

57 patients completed both pain tools. The mean age was 17.5 +/− 2.6 years (mean +/− SD). There were 29 females (51%) and 28 males (49%). 84% of the patients had Hb SS; 14% had Hb SC and 2% had Hb Sb⁰-thalassemia. Pain was described in every body segment, with the most frequent sites including the: back, legs, chest, and abdomen. Pain intensity was moderate for the average subject (mean pain intensity score out of 10 was 3.7 +/− 2.6 for PR and 4.3 +/− 3.2 with the APPT, r=.46, p<.01). The mean CPI was 201.1 +/− 26.9 with PR and 200 +/− 30.5 with the APPT (mean +/− SD). There was a strong correlation with the CPI between PR and the APPT (r=.73, p<.01). Mean PR CPI scores were not significantly different for females (206.5 +/− 29.7) and males (195.6 +/− 22.9). Mean APPT CPI scores were significantly different (p=.01) for females (206.3 +/− 35) than males (193.5 +/− 24.1). There were no differences in mean APPT CPI scores by genotype or age groups.

Pain in SCD patients is a common complication with significant morbidity. In this study we found on a single, outpatient comprehensive sickle cell clinic visit that patients had pain in every body segment and had pain in multiple body sites. Patients in this study had moderate pain during a routine outpatient clinic visit. The Composite Pain Index is a multidimensional representation of pain that can be determined with both the APPT and PR. This study demonstrates that both the APPT and PR produced similar CPI scores in pediatric and adult SCD patients. The gender differences in CPI scores produced by the APPT in comparison to PR is likely due to the APPT having only one pain intensity score (pain now) to contribute to the CPI whereas PR has 3 pain intensity scores (pain now, least and worst pain in previous 24 hours). The significance of this study is that the CPI may be an important outcome variable to allow researchers and clinicians to compare the complexities of the chronic pain that pediatric and adult patients with SCD experience.

Labotka:HemaQuest Pharmaceuticals, Inc: Research Funding.