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Web-based Monitoring of Pain Management in Adolescent and Young Adult Sickle Cell Patients Through Daily Self-Assessment

Smith, Meagan (2012) Web-based Monitoring of Pain Management in Adolescent and Young Adult Sickle Cell Patients Through Daily Self-Assessment. Master's Thesis, University of Pittsburgh. (Unpublished)

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There is a wide range of variability in the clinical phenotype of Sickle Cell Disease (SCD), resulting in a vast array of clinical presentations ranging from acute, recurrent vaso-occlusive pain episodes to chronic pain, increased risk of strokes, acute chest syndromes and osteonecrosis. Historically, pain crises have been defined by whether or not the patient seeks medical attention. Previous studies have shown that while patients with SCD are in pain 54.5% of the time, they are only seeking medical attention during 3.5% of these episodes. This has led to a gross underestimation of the prevalence of pain episodes, due to discrepancies in both the definition and reporting of these episodes. There is currently no utility available to accurately assess and manage pain levels in Sickle Cell patients who are not utilizing medical facilities. The implementation of a web-based application to monitor daily pain levels is relevant to public health because it is likely to provide medical teams with the tools necessary to track patient pain levels more precisely. This will also enable healthcare providers to be more proactive with regard to pain management in patients with SCD.
Twenty-nine patients were asked to record their level of pain three times daily for six months via a web-based application. The application asked patients to appraise their pain level by use of a Visual Analog Scale (VAS), ranging from 0 (no pain) to 10 (extreme pain). Each patient was assigned a non-specific identifier that enabled him or her to log into the system

without referencing any personal health information. Pain measurements were electronically time stamped and all information was filtered to ensure the protection of patient sensitive information. Authorized team members were alerted of pain episodes by email (pain levels of 5-
7) or text message (pain levels of 8-10). The patient was then contacted and information was gathered regarding the location and duration of pain, the presence of other symptoms and social factors that influenced a patient’s decision to seek medical intervention.
Of the 29 patients enrolled in the study, 21 patients accessed the web-based application and provided a total of 4,981 pain data entries over a six month time period. Patients reported that they were in no pain (pain score of 0) 23.4% of the days logged, in pain (pain score of 1-7)
76.6% of the days logged and in pain crisis (pain score of 8-10) 12.2% of the days logged.

This data provides proof of the principle that adolescents with SCD will provide electronic reports of their pain multiple times a day over an extended period of time. This preliminary data also suggests that the prevalence of pain in adolescents is much greater than previously reported.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Smith, Meaganmeo32@pitt.eduMEO32
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorKrishnamurti, Lakshmanan
Committee MemberGettig, Elizabeth bgettig@pitt.eduBGETTIG
Committee MemberKladny, Beth
Committee MemberBarmada, Michael barmada@pitt.eduBARMADA
Date: 2 July 2012
Date Type: Publication
Defense Date: 27 March 2013
Approval Date: 2 July 2012
Submission Date: 4 April 2012
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 69
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Genetic Counseling
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: web-based application, Sickle Cell Disease, pain management
Date Deposited: 02 Jul 2012 14:22
Last Modified: 15 Nov 2016 13:57


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