Variation in Pain and Clinical Indices among Patients with Sickle Cell Disease in Ghana

Abstract

Background: Patients with Sickle Cell Disease (SCD) have acute pain episodes that vary between patients. We examined whether differences exist in socio-demographic profiles, blood indices and pain attributed fear of movement in SCD. Methods: The study included 287 patients with SCD attending the outpatient SCD clinic of the Korle-Bu Teaching Hospital, Accra, Ghana. We documented socio-demographic information, clinical history and pain location at enrolment. Blood sample was also taken for hematological analysis. We used the numeric descriptor, verbal and visual analog scales to determine the site and spectrum of pain intensity, and the Tampa Scale of Kinesiophobia (TSK) to assess pain attributed fear of movement. Results: Patients with SCD were more literate than their healthy controls (χ2, p=0.0001). By genotypes, patients with HbSS were younger in age and had lower BMI, p=0.0001, 95% CI: -10.1 – 3.6; and p=0.01, 95% CI -4.13- 0.46. Pain was the most common clinical manifestation in both HbSS and HbSC (17.7% and 25.7% respectively) disease, presenting mainly as musculoskeletal pain (81.3%). Patients with HbSS were anemic, with indicators of hemolytic episodes and elevated WBCs and Platelets (p=0.0001.), depicting an inflammatory state. The disease profile of patients with HbSS was generally severer (OR= 1.695, 95% CI: 1.035-2.776 p=0.036) with a higher score of pain attributed fear of movement (p=0.0001, 95% CI: 2.2 – 6.0). Conclusion: Pain is a significant index of disease in patients with SCD, particularly in those with HbSS genotype leading to fear of movement. Efforts at involving patients in coping strategies and pain mitigation in management are warranted