Bridging Diagnostic Criteria and Clinical Practice: Feasibility of Chronic Pain Screening in Pediatric Patients with Sickle Cell Disease
Destiny C Uwaezuoke, Vanessa Igbeka, Wally R Smith, Deepika S Darbari, Olufunke MartinAbstract
Background
Pain is a common debilitating complication of sickle cell disease (SCD) and, during adolescence, it can progress from episodic vaso-occlusive episodes to chronic daily pain1,4. Chronic pain is associated with impaired quality of life and psychosocial dysfunction, but unfortunately, it is under-diagnosed1,7. Although consensus diagnostic criteria for chronic pain have been established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks–American Pain Society–Pain Taxonomy (AAPT), utilization of these criteria has been limited. We evaluated the feasibility of implementing a brief, chronic pain screening survey in a high-volume outpatient clinic and examined whether chronic pain could be reliably detected using a shorter time frame of symptom duration.
Methods
We conducted a prospective, single-center feasibility study in a pediatric SCD outpatient clinic with eligible patients 8–18 years. During comprehensive clinic visits, we used the “Chronic Pain SCRIPT” survey, a brief, consensus-informed screening instrument derived from the National Pain Strategy2 and the AAPT diagnostic criteria for chronic SCD-related pain3. Participants also completed validated measures including Centralized Pain Index, painDETECT, and PROMIS-25 questionnaires, in addition to a 14-day pain diary reproduced from the Pain in Sickle Cell Epidemiology Study (PiSCES)5. Associations between SCRIPT total scores and validated instruments were evaluated using Spearman rank correlation coefficients to account for ordinal data. Corresponding p-values were calculated to assess statistical significance. The use of 3-months as an assessment window to capture chronic pain was supported by the International Association for the Study of Pain and the National Heart, Lung, and Blood Institute. Feasibility outcomes included enrollment rates, survey completion time, and workflow integration to avoid clinic disruption. The secondary outcome was accuracy in identification of chronic pain using 3-months versus 6-months symptom duration criteria.
Results
Of 117 eligible patients, 61 were approached and 44 were enrolled, exceeding our predefined feasibility benchmark of enrolling ≥30% of eligible patients. The enrolled cohort included 24 females (55%) and 20 males (45%). Screening via the Chronic Pain SCRIPT survey was completed within 3 minutes on average and was integrated into clinic workflow without significant disruption per nursing staff. Survey completion rates exceeded 90%. Using the Chronic Pain SCRIPT survey with a 3-month symptom duration criterion, chronic pain was identified in 5 of 44 participants (11.4%). Using a 6-month symptom duration criterion, chronic pain was identified in 8 of 44 participants (18.2%). Overlap existed for 3 participants who met criteria using both definitions. SCRIPT total scores demonstrated statistically significant moderate to strong Spearman correlations with painDETECT total scores, PROMIS pain interference, PROMIS pain intensity, and measures of centralized pain burden, indicating meaningful concordance with established pain instruments2,6. Moderate correlations were also observed with PROMIS fatigue, anxiety, and depression, while an inverse association was observed with mobility (Figure 1), consistent with expected functional impairment patterns in chronic pain and centralized pain phenotypes in SCD4,7. Participants classified as having chronic pain exhibited higher pain burden, greater symptom interference, and increased healthcare utilization compared with those not meeting chronic pain criteria. Importantly, patterns of association between SCRIPT and validated measures were preserved when using the shorter 3-month assessment window, suggesting stable detection of chronic pain without reliance on longer recall periods.
Conclusions
Implementation of a brief, consensus-based chronic pain screening survey is feasible in pediatric SCD outpatient care. The Chronic Pain SCRIPT survey demonstrates meaningful agreement with validated pain measures and identifies a clinically relevant subgroup of youth with increased pain burden and functional impairment. Comparable concordance using a 3-month symptom duration criterion supports the use of shorter assessment intervals to facilitate earlier recognition of chronic pain in pediatric SCD. Embedding standardized screening into routine clinical care may represent a critical translational step toward timely, multidisciplinary chronic pain management1,7.