(132) Predictors of Opioid Analgesic Prescription in Adult Outpatients with Sickle Cell Disease

Opioid analgesics are the mainstay therapy for managing severe pain of sickle cell disease (SCD) for the 100,000 Americans afflicted with it. However, there is limited evidence on the contribution of sociodemographic and clinical factors as predictors of opioid prescription in adult outpatients with SCD. Using baseline data from an ongoing longitudinal clinical trial, the purpose of this descriptive, cross-sectional study was to determine sociodemographic and clinical factors that predict opioid prescription calculated as Morphine Sulfate Equivalent (MSEQ) in adult outpatients with SCD. Patients (N=186, mean age 36.6±11.7 years [19-74 years], 97% African American, 59% female) enrolled between March 2015 and August 2017 completed PAINReportIt, a computerized pain measure that obtains demographic questions, weight and medication profile. Patients also completed thermal and mechanical quantitative sensory testing (QST [heat/cold/mechanical pain thresholds]) at three body sites. Descriptive statistics, frequencies, and multivariate regression analysis were computed using R statistical software. Ninety-nine percent of outpatients were on analgesics prescription, including opioids (92%), NSAIDs (64%), and adjuvants (25%). Mean scores were: average pain intensity (API) (4.5±2.4 [range 0-9]), MSEQ (62.5±105.9 [range 0-525]), and weight (159.2±41.5). Thirty-one percent of patients had pain sensitization while 69% were not sensitized. Results of the multiple regression showed that API and adjuvant prescription were positively associated with MSEQ (p<.001 and p=.045, respectively). Age (p=.40), sex (p=.92), weight (p=.76), NSAIDs (p=.31), and pain sensitization (p=.50) were not significantly associated with MSEQ. Findings suggest that prescribers used two good pain management principles. Patients reporting higher pain intensity were more likely to be prescribed opioids in accordance with recommended use of the analgesic ladder. Patients prescribed opioids were more likely to be prescribed adjuvants consistent with use of a multimodal approach to pain control. Widespread prescriber implementation of these pain management principles will ensure better pain control for adult outpatients with SCD. Opioid analgesics are the mainstay therapy for managing severe pain of sickle cell disease (SCD) for the 100,000 Americans afflicted with it. However, there is limited evidence on the contribution of sociodemographic and clinical factors as predictors of opioid prescription in adult outpatients with SCD. Using baseline data from an ongoing longitudinal clinical trial, the purpose of this descriptive, cross-sectional study was to determine sociodemographic and clinical factors that predict opioid prescription calculated as Morphine Sulfate Equivalent (MSEQ) in adult outpatients with SCD. Patients (N=186, mean age 36.6±11.7 years [19-74 years], 97% African American, 59% female) enrolled between March 2015 and August 2017 completed PAINReportIt, a computerized pain measure that obtains demographic questions, weight and medication profile. Patients also completed thermal and mechanical quantitative sensory testing (QST [heat/cold/mechanical pain thresholds]) at three body sites. Descriptive statistics, frequencies, and multivariate regression analysis were computed using R statistical software. Ninety-nine percent of outpatients were on analgesics prescription, including opioids (92%), NSAIDs (64%), and adjuvants (25%). Mean scores were: average pain intensity (API) (4.5±2.4 [range 0-9]), MSEQ (62.5±105.9 [range 0-525]), and weight (159.2±41.5). Thirty-one percent of patients had pain sensitization while 69% were not sensitized. Results of the multiple regression showed that API and adjuvant prescription were positively associated with MSEQ (p<.001 and p=.045, respectively). Age (p=.40), sex (p=.92), weight (p=.76), NSAIDs (p=.31), and pain sensitization (p=.50) were not significantly associated with MSEQ. Findings suggest that prescribers used two good pain management principles. Patients reporting higher pain intensity were more likely to be prescribed opioids in accordance with recommended use of the analgesic ladder. Patients prescribed opioids were more likely to be prescribed adjuvants consistent with use of a multimodal approach to pain control. Widespread prescriber implementation of these pain management principles will ensure better pain control for adult outpatients with SCD.