Photo Credit: Liubomyr Vorona

Accurate pain reporting in sickle cell disease is critical to effective pain assessment and management, but accuracy depends on patient comprehension of forms.

Effective pain management starts with accurate pain assessment for patients with sickle cell disease (SCD). The Brief Pain Inventory-Short Form (BPI-SF) is a commonly used self-report tool, but its accuracy depends on patient comprehension.

Authors of a recent study published in Pain Reports explored whether cognitive function or education level influences how well adults with SCD complete the BPI-SF.

“Pain perception is highly subjective, and SCD pain is uniquely complex because it may be acute, chronic, nociceptive, neuropathic, or a combination of these, making it challenging for patients to communicate their experiences via clinical pain scales like the BPI,” wrote Julia A. O’Brien, PhD, RN, and colleagues. “Neurocognitive problems and limited education may influence the ability of patients with SCD to complete the BPI, which requires integration of multiple cognitive abilities.”

Researchers conducted a secondary data analysis from a study on brain aging and cognitive impairment in SCD. The study included 71 adults (43.7% male, 98.6% African American or mixed race) with an average of 13.6 years of education.

Participants completed neurocognitive tests measuring memory, attention, language, visuospatial skills, and literacy. Researchers analyzed their BPI-SF responses for errors and compared results based on cognitive and educational factors.

Key Findings

• Errors were common: 1% of participants incorrectly completed pain severity items, and 57.7% misinterpreted the body map item.
• Education level mattered: Participants with incorrect responses had an average of 2 fewer years of education than those who completed the BPI-SF correctly (P=0.004).
• Cognitive function was not a major factor: While lower neurocognitive scores were observed in those with errors, these differences lost significance after statistical adjustments.
• Literacy was not linked to errors: Reading ability did not significantly affect response accuracy.

The study authors concluded that education level appears to be a key factor in accurately completing pain assessment tools like the BPI-SF. These findings are particularly relevant for clinicians working with patients who may have limited formal education or face other barriers to comprehension.

“This finding has important implications in light of previous evidence that patients with SCD have lower academic attainment related to neurological problems and medical complications that affect school attendance and performance beginning early in life,” the researchers said.

How to Improve Pain Assessments

The study authors cautioned clinicians to carefully consider patients’ education levels when administering the BPI-SF. To ensure assessment accuracy, they recommended that clinicians:

• Use simpler language and shorter sentences in pain assessment tools;
• Provide clear timeframes to avoid confusion about reporting periods; and
• Consider interviewer-administered assessments for patients who struggle with self-report forms.

“Multiple questions on the BPI-SF request information about varying timeframes during which patients experience pain. Item 1 asks about pain today, items 3 and 4 refer to pain in the past 24 hours, item 6 asks about pain at the time of assessment, and items 2 and 5 do not provide patients with a time context to consider when reporting pain symptomology,” the researchers said, emphasizing that this could contribute to patients having difficulty accurately completing the assessment.

The researchers acknowledged several limitations of their study, such as small sample size, missing education data for some participants, and lack of non-SCD controls. They called for further research to confirm their findings in larger, more diverse populations and to explore alternative pain assessment methods.

“Assessing and treating pain in SCD is challenging, in part due to the subjective nature of pain and the reliance on patients’ perception of pain symptoms. However, accurate and reliable assessment of SCD pain is critical for developing effective interventions and should rely on well-validated, reliable pain assessment tools and patient interview,” Dr. O’Brien and colleagues concluded.