OBJECTIVE:This study aimed to comprehensively describe patient experiences with opioid-related transitions (OrTs) and identify modifiable gaps in care to improve pain management for individuals with rheumatic disease (RD). METHODS:We conducted a qualitative descriptive study with 20 participants with RD who had used prescribed opioids in the past year. Semistructured interviews were analyzed using conventional content analysis. RESULTS:We identified four themes. The first, "managing together, deciding alone," included the following subthemes: (a) clinician guidance in opioid use decision-making, (b) family involvement in opioid decision-making and advocacy, (c) self-directed opioid use strategies, and (d) risk-reduction strategies to prevent opioid addiction, dependence, and tolerance. The second, "turbulence of opioid medication changes," included the following subthemes: (a) evolving and dynamic opioid regimens, (b) disrupted access to opioid medications, and (c) the toll of opioid medication changes. The third, "transitions across opioid prescribers," included the following subthemes: (a) context of opioid prescriber changes, (b) drivers of opioid prescriber changes, (c) navigating opioid prescriber changes, and (d) reassurance of trusting relationships during opioid prescriber changes. The fourth, "opioid transitions across care settings," included the following subthemes: (a) shifts in opioid management across care settings, (b) home to hospital transitions: delayed access and needed advocacy, and (c) hospital to home transitions: adequacy, engagement, and unmet needs. CONCLUSION:Patients with RD frequently experience OrTs across multiple clinicians and care settings. Findings highlight the complexity, risks, patient burden, and suboptimal outcomes associated with these transitions and underscore the need for improved care coordination and innovative support.

BACKGROUND:cute musculoskeletal pain in emergency department (ED) patients is challenging to treat with medications alone, but adding acupuncture may improve pain outcomes. METHODS:In this pragmatic randomized controlled trial, acupuncture was delivered by licensed acupuncturists in the ED and twice a week in follow-up clinic for 1 month. From February 10, 2020 to April 19, 2023, 2781 adult patients at an academic ED with acute (≤7 days) musculoskeletal pain in neck, back and/or extremities were screened, and 599 were enrolled and randomized to usual care only (n = 189, 31.6%) or acupuncture plus usual care (n = 410, 68.4%). RESULTS:Acupuncture and control arms had similar demographics (mean age 45.2, SD 15.8; 57.7% female) and baseline pain scores (control 7.1, SD 2.2; acupuncture 7.1, SD 2.3). At 1 month, pain scores were similar between arms (control 3.8, SD 3.2; acupuncture 3.2, SD 3.0). However, 178 (43.4%) participants in the acupuncture arm were unable to attend acupuncture clinic and reported time and financial constraints. Exploratory analysis of pain score by number of clinic sessions attended showed that patients attending 6 or more acupuncture sessions (n = 121, 20.2%) experienced significant pain improvements compared to those with fewer sessions (n = 478, 79.8%). CONCLUSION:Improving access and availability of acupuncture in outpatient settings may be needed for more effective pain management.

Background Even though there is clear evidence supporting the use of complementary and integrative health (CIH) interventions for chronic pain, their integration into clinical care is challenging. Thus, the purpose of this study was to understand how the integration of CIH interventions, namely, guided relaxation and acupuncture evaluated in the Hybrid Effectiveness-Implementation Trial of Guided Relaxation and Acupuncture for Chronic Sickle Cell Disease Pain (GRACE Trial), would impact clinic workflow at each study site. Methods We conducted a qualitative descriptive study using individual interviews with healthcare providers and staff working at GRACE Trial sites. Interview data were analyzed using modified rapid qualitative analysis. Results We interviewed 13 healthcare providers from three GRACE Trial sites. Two major themes were identified: (1) the variable impact of CIH integration on clinic operations, and (2) the introduction of CIH interventions into clinical practice. Conclusion This study highlights the importance and value of participatory approaches in integrating CIH interventions into healthcare settings. This study contributes to the CIH literature by addressing chronic pain and informing the identification of strategies to target the multi-layered challenges of integrating evidence-based CIH interventions into practice.

OBJECTIVES:The purpose of this study is to review multidimensional pain assessment measures in older adults. DESIGN:This study is a scoping review. DATA SOURCES:Articles in peer-reviewed journals describing development or psychometric testing of multidimensional pain measures in older adults aged 60 and over were included. Articles were from Ovid MEDLINE, Embase (Elsevier), and CINAHL Complete (EBSCOhost) and published from database inception to 7 August 2024. REVIEW/ANALYSIS METHODS:Articles were retrieved using a search strategy guided by medical librarians. After article screening by two authors (first by title/abstract and then full text review), data were extracted in Covidence software describing the setting and sample of each study as well as dimensions of pain measured, language, and psychometric properties. Data tables were developed and synthesized to identify patterns, trends, and gaps in the literature. RESULTS:Thirty-two articles were included for review describing studies from 17 countries of measures in 15 languages. Pain intensity, interference, and affect/mood were the most measured dimensions. Internal consistency and test-retest reliability were the most common forms of reliability measured while construct, concurrent, and convergent validity were the most common forms of validity. There is significant heterogeneity among the studies and measures. There is no strong evidence for one measure to be recommended for use in older adults. CONCLUSIONS:This scoping review found that the current tools measuring pain in older adults cover the dimensions of pain intensity, pain interference, and affect/mood. Given the interindividual variability in co-morbidities and ability to communicate pain in older adult populations, ongoing development and further validation of the multidimensional assessment tools continues to be needed. NURSING PRACTICE IMPLICATIONS:Nurses should use established multidimensional measures for pain assessment in older adults and promote the ongoing development and validation of measures for this population.

Purpose/Objectives: Sickle cell disease (SCD) is a complex genetic hemoglobinopathy which is associated with a severely shortened lifespan; the median age of death remains in the low 50’s. Individuals living with SCD have complex medical, psychological, and social needs. The complexity results in difficulty navigating the healthcare system, and often being unaware of existing resources that may assist with addressing unmet social needs. Navigating fragmented healthcare and other support systems, as well as ensuring access to care, is challenging for persons with complex chronic diseases such as those living with SCD. Most healthcare institutions do not use SCD-specific nurse navigation models. The purpose is to describe an evidence-based SCD practice model for nurse navigation to improve the quality of whole-person healthcare delivery. Primary Practice Settings: Care for individuals with SCD. Findings/Conclusions: This disease-focused, nurse navigation model was adapted from effective models and theories. The authors identify and describe nurse navigator competencies, including care coordination, patient education and support, communication, and expertise in SCD care delivery. Each of these competencies is operationalized into core and adaptable intervention components in this model to improve the quality of life and longevity of individuals living with SCD. Implications for Case Management Practice: Nurse navigators are required to understand and manage the care of individuals with complex healthcare needs. The authors identified a comprehensive model that clearly delineates the most effective components of nurse navigation for SCD that can be adopted to a variety of healthcare and community settings to achieve the highest likelihood of meeting whole person healthcare delivery needs. Partnering with community-based organizations, healthcare systems, and government resources is critical.

BACKGROUND:People who are prescribed opioids for pain management may undergo transitions of care. However, little is known about transitions of care that involve a prescribed opioid, which may have significant consequences for people with chronic pain. The purpose of this concept analysis was to define opioid-related transitions (OrTs) and characterize their attributes, antecedents, and consequences. METHODS:Rodger's evolutionary method for concept analysis was used to identify key attributes, antecedents, and consequences of OrTs. A comprehensive literature search was conducted in September 2024, resulting in the inclusion of 61 articles. RESULTS:As defined, OrTs occur when opioids are prescribed for chronic pain management and involve an opioid medication transition and/or transition in care settings and/or practitioners. These transitions encompass patient-clinician and clinician-clinician interactions that ideally incorporate opioid-specific information, clear communication, shared decision-making, collective responsibility, weighing the risks and benefits, and knowledge exchange during the processes of opioid prescribing, management, and monitoring. During OrTs, patients and clinicians identified a need for support with care coordination. Notably, team-based involvement in OrTs is present, but guidance for operationalizing patient and clinician support efforts is needed. CONCLUSIONS:This concept analysis contributes to the conceptual clarity of OrTs by identifying core attributes, antecedents, and consequences. By defining and examining OrTs broadly and including chronic pain, both patient experiences and clinician approaches to managing pain during transitions of care are highlighted. Research is needed on patient and clinician experiences related to managing chronic pain with opioids and the role of nurse-led interventions during OrTs.

Sickle cell disease (SCD) affects similar to 100 000 predominantly African American individuals in the United States, causing significant cellular damage, increased disease complications, and premature death. However, the contribution of epigenetic factors to SCD pathophysiology remains relatively unexplored. DNA methylation (DNAm), a primary epigenetic mechanism for regulating gene expression in response to the environment, is an important driver of normal cellular aging. Several DNAm epigenetic clocks have been developed to serve as a proxy for cellular aging. We calculated the epigenetic ages of 89 adults with SCD (mean age, 30.64 years; 60.64% female) using 5 published epigenetic clocks: Horvath, Hannum, PhenoAge, GrimAge, and DunedinPACE. We hypothesized that in chronic disease, such as SCD, individuals would demonstrate epigenetic age acceleration, but the results differed depending on the clock used. Recently developed clocks more consistently demonstrated acceleration (GrimAge, DunedinPACE). Additional demographic and clinical phenotypes were analyzed to explore their association with epigenetic age estimates. Chronological age was significantly correlated with epigenetic age in all clocks (Horvath, r = 0.88; Hannum, r = 0.89; PhenoAge, r = 0.85; GrimAge, r = 0.88; DunedinPACE, r = 0.34). The SCD genotype was associated with 2 clocks (PhenoAge, P = .02; DunedinPACE, P < .001). Genetic ancestry, biological sex, beta-globin haplotypes, BCL11A rs11886868, and SCD severity were not associated. These findings, among the first to interrogate epigenetic aging in adults with SCD, demonstrate epigenetic age acceleration with recently developed epigenetic clocks but not older-generation clocks. Further development of epigenetic clocks may improve their predictive ability and utility for chronic diseases such as SCD.

BACKGROUND:Sickle cell disease (SCD) is a chronic medical condition characterized by red blood cell sickling, vaso-occlusion, hemolytic anemia, and subsequently, end-organ damage and reduced survival. Because of this significant pathophysiology and early mortality, we hypothesized that patients with SCD are experiencing accelerated biological aging compared with individuals without SCD. METHODS:We utilized the DunedinPACE measure to compare the epigenetic pace of aging in 131 Black Americans with SCD to 1391 Black American veterans without SCD. RESULTS:SCD patients displayed a significantly accelerated pace of aging (DunedinPACE mean difference of 0.057 points) compared with the veterans without SCD, whereby SCD patients were aging ≈0.7 months more per year than those without SCD (p = 4.49 × 10-8). This was true, even though the SCD patients were significantly younger according to chronological age than the individuals without SCD, making the epigenetic aging discrepancy even more apparent. This association became stronger when we removed individuals with posttraumatic stress disorder from the non-SCD group (p = 2.18 × 10-9), and stronger still when we restricted the SCD patients to those with hemoglobin SS and Sβ0 thalassemia genotypes (p = 1.61 × 10-10). CONCLUSIONS:These data support our hypothesis that individuals with SCD experience accelerated biological aging as measured by global epigenetic variation. The assessment of epigenetic measures of biological aging may prove useful to identify which SCD patients would most benefit from clinical interventions to reduce mortality.

Disparities, inequities, and injustices in populations with pain are historically pervasive and lead to deleterious patient outcomes and perpetuate systemic barriers to achieving equitable pain management. The American Society for Pain Management Nursing (ASPMN) upholds the principle that all persons with pain have equal rights to evidence-based, high quality pain assessment, management, and treatment. Intervening at multilevels (i.e., individual, interpersonal, community, societal) is necessary to ascertain that just and equitable pain care is provided to all populations.

Objectives Over 50% of adults living with sickle cell disease (SCD) have chronic pain, but the underlying mechanisms of chronic pain in this population remain unclear. Quantitative sensory testing is an important measurement tool for understanding pain and sensory processing. This scoping review summarizes quantitative sensory testing methodologies used in sickle cell studies and the evidence for central sensitization in this population.Methods We conducted a systematic search of PubMed, Embase, and CINAHL to identify studies using quantitative sensory testing in individuals living with sickle cell disease. Search strategies were based on variations of the terms "sickle cell disease," and "quantitative sensory testing." Eligible studies were observational or experimental studies in human participants living with SCD that reported findings and detailed methodology for at least 1 quantitative sensory testing modality.Results Our search yielded a total of 274 records; 27 of which are included in this scoping review. Of the 27 studies, 17 were original studies (with combined total of 516 adult and 298 pediatric participants), and 10 were secondary or subgroup analyses of these prior studies. Significant variation existed in quantitative sensory testing methodologies across studies, including testing locations, type and intensity of stimuli, and interpretation of findings. Of the identified studies, 22% (2/9 studies) reported sensory abnormalities in mechanical sensitivity and thresholds, 22% (2/9 studies) reported abnormal pressure pain thresholds, 46% (6/13 studies) reported sensory abnormalities in thermal pain thresholds and tolerance (cold and warm), and 50% (2/4 studies) reported abnormalities in temporal summation.Conclusion Future studies should use standardized quantitative sensory testing protocols with consistent and operationalized definitions of sensitization to provide clear insight about pain processing and central sensitization in sickle cell disease.

BACKGROUND:Opioid use disorder is a national epidemic that has killed over one million United States residents since 1999. Randolph County, North Carolina (NC) has a significantly higher rate of drug overdose and emergency-department-related visits than the NC state average. Primary care providers are well positioned to intervene and offer screening, referral, and treatment of opioid use disorder, yet this does not often occur. OBJECTIVE:This quality improvement project serves as a pilot to evaluate the effectiveness of academic detailing (AD) to increase screening, referral, and treatment of opioid use disorder as well as to increase knowledge of community resources available. METHODS:Face-to-face one-to-one AD was provided to primary care providers. Content included an overview of the diagnosis, standardized screening tools, management, and community resources available for referral. Assessments pre and post were conducted to evaluate screening, referral and treatment practices, knowledge of available community resources, barriers to providing services, and satisfaction with the AD event. RESULTS:AD did not result in change in frequency of screening or referral for treatment for OUD. None of the providers who participated in the intervention were prescribing buprenorphine prior to the event, nor were they after the event. Results indicated that there was an increase in the knowledge level of providers after AD with a change in median knowledge level from "I know about some resources in the area" to "I am very knowledgeable about area resources." Barriers to screening, referral, and treatment were identified, with lack of time being the most frequently cited. CONCLUSIONS:AD did not increase screening, referral, or treatment of OUD in this pilot project. However, there was an increase in knowledge of community resources related to OUD. AD is labor and time intensive and may be difficult to scale. IMPLICATIONS FOR NURSING:Providers are well positioned to impact patient lives and increase screening, referral, and treatment for OUD in primary care settings. Continued work is needed to overcome barriers for getting patients adequate OUD treatment. Additional research is needed to ascertain if varied forms of AD would be more time and cost effective.

Background: Acupuncture is a widely practiced complementary and integrative health modality that has multiple clinical applications. The use of acupuncture in the United States is rapidly increasing. Although studies have shown the efficacy and effectiveness of acupuncture for various ailments, the integration of acupuncture into the U.S. health care system remains a challenge. Little is known about the factors affecting this integration. Objective: To provide a systematic review of the barriers and facilitators affecting the integration of acupuncture into the U.S. health care system. Methods: Four electronic databases were searched. Three independent reviewers were involved in the screening and data charting processes. Findings were synthesized and categorized into four levels based on the Social Ecological Model. Results: A total of 22 studies were included in the final review. The barriers and facilitators affecting the integration of acupuncture were mapped into four levels (individual, interpersonal, organizational, and policy). The most frequently reported barriers and facilitators were mapped into the Social Ecological Model constructs within the "Individual" level (i.e., beliefs and attitudes of acupuncture, and practical issues) and the "Organizational" level (i.e., credentialing, space and facility, referral system). Conclusion: This review has identified and synthesized the breadth of evidence on the barriers and facilitators to the integration of acupuncture into the U.S. health care system. Results of this review will guide future implementation studies to develop and test implementation strategies to integrate acupuncture into the U.S. health care system.

STUDY OBJECTIVE:Acute musculoskeletal pain in emergency department (ED) patients is frequently severe and challenging to treat with medications alone. The purpose of this study was to determine the feasibility, acceptability, and effectiveness of adding ED acupuncture to treat acute episodes of musculoskeletal pain in the neck, back, and extremities. METHODS:In this pragmatic 2-stage adaptive open-label randomized clinical trial, Stage 1 identified whether auricular acupuncture (AA; based on the battlefield acupuncture protocol) or peripheral acupuncture (PA; needles in head, neck, and extremities only), when added to usual care was more feasible, acceptable, and efficacious in the ED. Stage 2 assessed effectiveness of the selected acupuncture intervention(s) on pain reduction compared to usual care only (UC). Licensed acupuncturists delivered AA and PA. They saw and evaluated but did not deliver acupuncture to the UC group as an attention control. All participants received UC from blinded ED providers. Primary outcome was 1-hour change in 11-point pain numeric rating scale. RESULTS:Stage 1 interim analysis found both acupuncture styles similar, so Stage 2 continued all 3 treatment arms. Among 236 participants randomized, demographics and baseline pain were comparable across groups. When compared to UC alone, reduction in pain was 1.6 (95% confidence interval [CI]: 0.7 to 2.6) points greater for AA+UC and 1.2 (95% CI: 0.3 to 2.1) points greater for PA+UC patients. Participants in both treatment arms reported high satisfaction with acupuncture. CONCLUSION:ED acupuncture is feasible and acceptable and can reduce acute musculoskeletal pain better than UC alone.

We aimed to determine minimally clinically important difference (MCID) in pain severity and agreement between the visual analog scale (VAS) and the verbal numeric rating scale (NRS) in people with sickle cell disease experiencing an acute vaso-occlusive episode in the emergency department (ED). In the COMPARE-VOE trial (NCT03933397), participants were administered the VAS (0-100), NRS (0-100), and verbal categorical rating of pain scale (a lot better, a little better, same, a little worse, much worse) every 30 minutes while in the ED. Data from 104 people (mean age 30.3 years; 61.5% female) were included in the analyses. To assess the MCID for the VAS & NRS, 256 VAS and 151 NRS observations were used to calculate mean differences and 95% confidence intervals (CI) between current and preceding scores when the participant reported "a little worse" or "a little better" pain for each scale. Pearson correlation and the Bland Altmann method were used to assess the agreement among 415 paired VAS & NRS observations. Our results indicated the MCID for the VAS was -8.88 mm (95% CI: -11.02 mm to -7.51 mm) and the NRS was -8.44 mm (95% CI: -11.81 to -6.59). The VAS & NRS scales had a correlation of 0.88 (p<0.001). The Bland Altmann indicated a mean difference of ±1.96 and limits of agreement ranging from 20 to -29. Despite high correlation, there was considerable variability of agreement between the VAS and NRS scales indicating the scales are not interchangeable to assess pain during a vaso-occlusive event. Funding: UH3HL137856.

ABSTRACT:Dilemmas regarding opioid prescribing for chronic pain frequently occur within health care settings. The ethical principles of autonomy, beneficence, nonmaleficence, and justice, as well as the principles of care ethics, can assist in addressing these opioid-related dilemmas. The purpose of this clinical case study is to provide a case study highlighting an opioid prescribing dilemma and then identify opioid-related transition considerations; address ethical questions that nurse practitioners (NPs) may encounter in clinical practice when providing care for individuals living with chronic pain who may need or use a prescribed opioid medication; and draw on the ethical principles and care ethics to provide guidance for NPs who face these challenging issues.

We aimed to determine the minimal clinically important difference (MCID) in pain severity and agreement between the visual analog scale (VAS) and the verbal numeric rating scale (NRS) in people with sickle cell disease experiencing an acute vaso-occlusive episode in the emergency department (ED). In the COMPARE-VOE trial (NCT03933397), participants were administered the VAS (0-100), NRS (0-100), and descriptor scale (a lot better, a little better, same, a little worse, much worse) every 30 minutes while in the ED. We analyzed data from 100 participants (mean age 30.2 years; 61% female). We calculated the mean differences and 95% confidence intervals (CI) between current and preceding scores when the participant reported a little worse or a little better pain for each scale (255 VAS and 150 NRS observations) to assess the MCID for the VAS & NRS. Pearson correlation and the Bland Altmann method were used to assess the agreement among 411 paired VAS & NRS observations. Our results indicated that the MCID for the VAS was 8.77 mm (95% CI: 7.43 mm, 10.83 mm) and the NRS was 8.29 (95% CI: 6.47, 11.60). The VAS & NRS scales had a correlation of 0.88 (p < 0.001). The Bland Altmann indicated a mean difference of -4.6 ±1.96 and the 95% limits of agreement ranged from 20 to -29. Despite high correlation, there was considerable variability of agreement between the VAS and NRS scales, indicating that these scales are not interchangeable to assess pain during a vaso-occlusive event. Perspective The average MCID in pain severity for individuals with sickle cell disease experiencing a VOE using the VAS (8.77 mm) is lower than previously reported, and the MCID for NRS was (8.29). We assessed the agreement between the VAS and NRS and determined that the scales cannot be used interchangeably to measure SCD pain intensity.

ObjectiveSickle cell disease (SCD) is associated with complications during pregnancy and can negatively influence maternal outcomes. Our study aimed to determine the prevalence and predictors of maternal morbidity among participants enrolled in an eight-site SCD Implementation Consortium (SCDIC) registry.MethodsWe conducted a cross-sectional analysis of female registry participants, aged 15-45 years, with a confirmed diagnosis of SCD. Participants completed a survey of self-reported pregnancies and outcomes.ResultsSeven hundred and thirty-eight individuals had at least one pregnancy event, with 1076 live births. Twenty percent reported a pregnancy loss or fetal demise. Of the 1076 live births, 75% involved at least one complication. The most prevalent complications were pain crises (61.1%) and pregnancy requiring blood transfusion(s) (33.0%). Multiparous individuals with a prior occurrence of a complication in a previous pregnancy had higher odds of recurrence of the same complication in subsequent pregnancies (i.e., previous acute crisis was associated with subsequent acute pain events odds ratio [OR]: 3.13; 95% confidence interval [CI]: 2.06-4.76) and prior transfusion requiring another transfusion (OR: 3.22; 95% CI: 2.01-5.16).ResultsSeven hundred and thirty-eight individuals had at least one pregnancy event, with 1076 live births. Twenty percent reported a pregnancy loss or fetal demise. Of the 1076 live births, 75% involved at least one complication. The most prevalent complications were pain crises (61.1%) and pregnancy requiring blood transfusion(s) (33.0%). Multiparous individuals with a prior occurrence of a complication in a previous pregnancy had higher odds of recurrence of the same complication in subsequent pregnancies (i.e., previous acute crisis was associated with subsequent acute pain events odds ratio [OR]: 3.13; 95% confidence interval [CI]: 2.06-4.76) and prior transfusion requiring another transfusion (OR: 3.22; 95% CI: 2.01-5.16).ConclusionIndividuals reported a high prevalence of pregnancy loss and maternal complications. Our findings underscore the importance of preconception counseling and early initiation of perinatal care in SCD.

The American Society for Pain Management Nursing (ASPMN) upholds the principle that all persons with pain have equal rights to evidence-based, high quality pain assessment, management, and treatment. This practice recommendation's goals are to 1) summarize known pain-related disparities, inequities, and injustices among commonly marginalized and at risk groups, 2) offer recommendations to ascertain that just and equitable pain care is provided to all people, and 3) outline a call to action for all nurses to embrace diversity, equity, inclusion, and a sense of belonging in order to mitigate pain-related disparities, inequities, and injustices within clinical environments and the nursing profession. This paper provides background and rationale for the 2024 ASPMN position statement on disparities, inequities and injustices in people with pain.

Objective: Sickle cell disease (SCD), the most common inherited blood disorder in the United States, is associated with severe psychoneurological symptoms. While epigenetic age acceleration has been linked to psychoneurological symptom burden in other diseases, this connection is unexplored in SCD. This study aimed to assess the association between epigenetic age acceleration and psychoneurological symptom burden in SCD. Methods: In this cross-sectional study, emotional impact, pain impact, sleep impact, social functioning, and cognitive function were assessed in 87 adults living with SCD. DNA methylation data were generated from blood specimens and used to calculate epigenetic age using five clocks (Horvath, Hannum, PhenoAge, GrimAge, & DunedinPACE). Associations between epigenetic age acceleration and symptoms were assessed. Results: The sample ( N = 87) had a mean (SD) chronologic age was 30.6 (8.1) years. Epigenetic age acceleration was associated with several symptom outcomes. GrimAge age acceleration (β = −0.49, p = .03) and increased DunedinPACE (β = −2.23, p = .004) were associated with worse emotional impact scores. PhenoAge (β = −0.32, p = .04) and the GrimAge (β = −0.48, p = .05) age acceleration were associated with worse pain impact scores. Increased DunedinPACE (β = −2.07 p = .04) were associated with worse sleep impact scores. Increased DunedinPACE (β = −2.87, p = .005) was associated with worse social functioning scores. We did not find associations between epigenetic age acceleration and cognitive function in this sample. Conclusion: Epigenetic age acceleration was associated with worse symptom experiences, suggesting the potential for epigenetic age acceleration as a biomarker to aid in risk stratification or targets for intervention to mitigate symptom burden in SCD.