Optimism Moderating the Relationship Between Pain and Medication Use in Adolescents with Sickle Cell

1
Optimism Moderating the Relationship Between Pain
and Medication Use in Adolescents with Sickle
Cell Disease Laura B. Pence, B. A.1, Cecelia R.
Valrie, M. A.2, Karen M. Gil, Ph. D.2, Rupa
Redding-Lallinger, M. D.2, and Charles Daeschner,
M. D.3 1University of Alabama, 2University of
North Carolina at Chapel Hill, 3East Carolina
University

• Pearson Correlations
• High pain severity was positively related to high
  analgesic use (r .64, p lt .01) and high
  narcotic use (r .80, p lt .05). High pain
  frequency was positively related to high
  analgesic use (r .52, p lt .01) and high
  narcotic use (r .88, p lt .01).
• Optimism was not significantly related to other
  factors in the study.
• Regression Model Predicting Analgesic Use
• SCD pain severity uniquely accounted for 23 of
  the variability in analgesic use (ß .68, p lt
  .01), such that high pain severity was related to
  high analgesic use.
• Optimism and the interaction between pain
  severity and optimism was not significantly
  related to analgesic use.
• Regression Model Predicting Narcotic Use
• SCD pain severity uniquely accounted for 19 of
  the variability in narcotic use (ß .61, p lt
  .01).
• Interaction between SCD pain severity and
  optimism uniquely accounted for 10 of the
  variability in narcotic use (p lt .01).
• As optimism levels decreased, the strength of the
  positive relationship between SCD pain severity
  and narcotic use decreased.

• Design Measures
• Adolescent and parent interviews during clinic or
  home visit
• Adolescent completed daily diaries for 3 6
  months
• Interview Measures
• Life Orientation Test (LOT)
• Parent or guardian information sheet
• Daily Diary
• Assessed pain severity and frequency, and pain
  medication use
• Participants

Abstract This study examined the influence of
optimism on pain medication use in adolescents
with sickle cell disease (SCD) (n 27 18
females, 9 males). Participants completed a
baseline measure of optimism and an average of
100 daily diary assessments of pain severity and
medication use. Results indicated that
adolescents who experienced more severe pain used
more analgesic and narcotic medications.
Optimism was a significant moderator of the
relation between pain and narcotic medication
use. At medium and high levels of optimism, pain
was positively related to narcotics use, but at
low levels of optimism, the same relation was not
present, suggesting that more optimistic
adolescents are better able to match their
medication use to their pain severity. Future
research should examine how other psychosocial
factors might influence pain medication use in
adolescents and adults who experience pain, and
clinicians should take into account psychosocial
factors when working with pain populations.
Background Sickle cell disease (SCD) is a
genetic disorder affecting approximately 1 in 600
African Americans. It alters the structure of
hemoglobin and causes normal donut shaped cells
to be crescent or sickle shaped. The most
prevalent complication associated with SCD is
pain episodes caused by tissue damage. Cells
damaged from the sickling process flow poorly,
stick to the lining of blood vessels, and create
blocks that obstruct blood flow, leading to pain
and organ damage over time. The onset, duration,
frequency, and intensity of SCD pain vary greatly
within the clinical population. Research has
shown that adolescents with SCD usually manage
their pain at home, primarily through the use of
pain medications (e.g., analgesics and
narcotics). However, there is limited research
assessing the influence of psychosocial
variables, such as optimism, on pain medication
use. Dispositional optimism has been shown to
effect pain severity and other factors related to
the pain experience. Purpose of the Study To
investigate optimism as a possible moderator of
the relationship between pain and pain medication
use in adolescents with SCD. Optimism
Pain Medication Use