Pain management and symptoms of substance dependence among patients with sickle cell disease

2.50
Hdl Handle:
http://hdl.handle.net/10545/192733
Title:
Pain management and symptoms of substance dependence among patients with sickle cell disease
Authors:
Elander, James ( 0000-0001-7665-5482 ) ; Lusher, Joanne; Bevan, David; Telfer, Paul
Abstract:
Concerns about dependence on prescribed analgesia may compromise pain management, but there was previously little reliable evidence about substance dependence among patients with sickle cell disease (SCD). We conducted indepth, semi-structured interviews with SCD patients in London, UK, to assess DSM-IV symptoms of substance dependence and abuse. Criteria were applied to differentiate between pain-related symptoms, which corresponded to the DSM-IV symptoms but involved analgesics used to control pain, and non-pain-related symptoms, which involved analgesic use beyond pain management. Pain-related symptoms are informative about how the pattern of recurrent acute pain in SCD may make patients vulnerable to perceptions of drug dependence. Non-pain-related symptoms are informative about more stringently defined dependence on analgesia in SCD. Inter-rater reliability was high, with mean Kappa coefficients of 0.67–0.88. The criteria could be used to assess analgesic dependence in other painful conditions. Pain-related symptoms were more frequent, accounting for 88% of all symptoms reported. When pain-related symptoms were included in the assessment, 31% of the sample met the DSM-IV criteria for substance dependence, compared with only 2% when the assessment was restricted to non-pain-related symptoms. Qualitative analysis of participants’ descriptions of analgesic use showed that active coping attempts (attempts to anticipate pain and avoid hospital admissions) and awareness of dependence were themes in descriptions of both pain-related and non-painrelated symptoms. Seeking a more normal lifestyle and impaired activities were themes associated with pain-related symptoms. Psychological disturbance was a theme associated with non-pain-related symptoms. The implications are for more responsive treatment of pain in SCD and greater awareness of how patients’ pain coping may be perceived as analgesic dependence. Further research could examine ways that pain-related and non-pain-related symptoms of dependence may be associated with other pain coping strategies and with the outcomes of treatment for painful episodes in hospital.
Affiliation:
University of Derby
Citation:
Pain management and symptoms of substance dependence among patients with sickle cell disease 2003, 57 (9):1683 Social Science & Medicine
Journal:
Social Science & Medicine
Issue Date:
2003
URI:
http://hdl.handle.net/10545/192733
DOI:
10.1016/S0277-9536(02)00553-1
Additional Links:
http://linkinghub.elsevier.com/retrieve/pii/S0277953602005531
Type:
Article
Language:
en
Description:
A study of use of painkillers among people with sickle cell disease, focusing specifically on the question of addiction to painkillers
ISSN:
02779536
Sponsors:
REMEDI
Appears in Collections:
Centre for Psychological Research

Full metadata record

DC FieldValue Language
dc.contributor.authorElander, Jamesen
dc.contributor.authorLusher, Joanneen
dc.contributor.authorBevan, Daviden
dc.contributor.authorTelfer, Paulen
dc.date.accessioned2011-12-01T09:34:16Z-
dc.date.available2011-12-01T09:34:16Z-
dc.date.issued2003-
dc.identifier.citationPain management and symptoms of substance dependence among patients with sickle cell disease 2003, 57 (9):1683 Social Science & Medicineen
dc.identifier.issn02779536-
dc.identifier.doi10.1016/S0277-9536(02)00553-1-
dc.identifier.urihttp://hdl.handle.net/10545/192733-
dc.descriptionA study of use of painkillers among people with sickle cell disease, focusing specifically on the question of addiction to painkillersen
dc.description.abstractConcerns about dependence on prescribed analgesia may compromise pain management, but there was previously little reliable evidence about substance dependence among patients with sickle cell disease (SCD). We conducted indepth, semi-structured interviews with SCD patients in London, UK, to assess DSM-IV symptoms of substance dependence and abuse. Criteria were applied to differentiate between pain-related symptoms, which corresponded to the DSM-IV symptoms but involved analgesics used to control pain, and non-pain-related symptoms, which involved analgesic use beyond pain management. Pain-related symptoms are informative about how the pattern of recurrent acute pain in SCD may make patients vulnerable to perceptions of drug dependence. Non-pain-related symptoms are informative about more stringently defined dependence on analgesia in SCD. Inter-rater reliability was high, with mean Kappa coefficients of 0.67–0.88. The criteria could be used to assess analgesic dependence in other painful conditions. Pain-related symptoms were more frequent, accounting for 88% of all symptoms reported. When pain-related symptoms were included in the assessment, 31% of the sample met the DSM-IV criteria for substance dependence, compared with only 2% when the assessment was restricted to non-pain-related symptoms. Qualitative analysis of participants’ descriptions of analgesic use showed that active coping attempts (attempts to anticipate pain and avoid hospital admissions) and awareness of dependence were themes in descriptions of both pain-related and non-painrelated symptoms. Seeking a more normal lifestyle and impaired activities were themes associated with pain-related symptoms. Psychological disturbance was a theme associated with non-pain-related symptoms. The implications are for more responsive treatment of pain in SCD and greater awareness of how patients’ pain coping may be perceived as analgesic dependence. Further research could examine ways that pain-related and non-pain-related symptoms of dependence may be associated with other pain coping strategies and with the outcomes of treatment for painful episodes in hospital.en
dc.description.sponsorshipREMEDIen
dc.language.isoenen
dc.relation.urlhttp://linkinghub.elsevier.com/retrieve/pii/S0277953602005531en
dc.subjectSickle cell diseaseen
dc.subjectPainkillersen
dc.titlePain management and symptoms of substance dependence among patients with sickle cell diseaseen
dc.typeArticleen
dc.contributor.departmentUniversity of Derbyen
dc.identifier.journalSocial Science & Medicineen
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