Knisely Submits Duke CTSI Application

Kudos to Mitch Knisely, assistant professor, and his entire team for the submission of their Duke CTSI application entitled "Biopsychosocial Determinants of Pain in Sickle Cell Disease." This proposal requests funding for a one-year period with a start date of March 1, 2019. 

Severe pain is among the most common and deleterious symptoms experienced by individuals with Sickle Cell Disease (SCD). Other than opioids, there are few effective treatments to manage pain in this population. More than half (55%) of adults with SCD report pain on the majority of days in a 6-month period, with 29% reporting pain ≥95% of the days. Most pain days occur in the absence of an acute pain crisis, underscoring the presence of persistent, or chronic, pain in this population. However, there is a limited understanding of the psychosocial factors and mechanisms unique to the development of persistent SCD pain.

A better understanding of the complexity of pain experiences, as well as psychosocial and biological determinants, can lead to improved assessment and management of pain in this population. Specific aims for this exploratory, cross-sectional study of 48 individuals who are 15 years and older and have SCD are to: (1) test the feasibility of blood specimen collection over a 6-month time frame; (2) determine three pain phenotypes (i.e., no pain, episodic severe pain, persistent severe pain) based upon participant responses to a validated SCD pain measure asking the occurrence of severe pain in the last six months; (2a) explore associations between pain phenotypes and demographic, disease, treatment, and psychosocial characteristics; and (2b) determine differences in serum cytokine levels between people with different pain phenotypes and healthy controls. This study will use self-report and electronic health record data being collected at Duke for the Sickle Cell Disease Implementation Consortium (SCDIC) Registry [5U01HL133964].

Ultimately, findings from this line of research can assist clinicians in identifying patients predisposed for high pain burden and potential new targets for non-opioid interventions to prevent or manage pain in this population.