Changes in intensity, location, and quality of vaso-occlusive pain in children with sickle cell disease.

A descriptive, longitudinal design was used to examine changes in current, worst, and least pain intensity during hospitalization for a vaso-occlusive episode in children with sickle cell disease. Other dimensions of the pain experience including location and quality were also evaluated. Children reported severe pain on the day of admission with 50% of the episodes showing a current pain intensity score of >70 and a worst pain intensity score of >80. Although both pain intensity scores demonstrated statistically significant decreases by approximately 5% over the course of the hospitalization, these decreases were not clinically significant based on the recommendations made in the American Pain Society's Guideline for the management of acute and chronic pain in sickle cell disease. In contrast to the pain intensity ratings, which did not decrease in 25% of the episodes, pain location surface area decreased in 100% of the episodes. Children described the quality of vaso-occlusive pain using all categories of word descriptors from the adolescent pediatric pain tool. These findings suggest that pain associated with a vaso-occlusive episode is inadequately assessed and managed during hospitalization.