Cognitive elaboration of pain in sickle-cell disease: A comparative evaluation in adults and children

The aim of this study was to analyze developmental issues in the experience of pain in patients with Sickle cell disease (SCD); a hereditary chronic hemolytic anemia characterized by pain crises. The perception of pain and its impact on psychological development varies with age, the supporting role of the family, the person's cognitions, and prior painful experiences. Methods. We compared 19 affected children to 21 adult patients, in terms of differences in perception, tolerability, affective reaction, pain projection and social adjustment consequent to the disease. Standardized measures were used to assess developmental differences. Results. The subjective perception of pain was less dramatic in children than in adults, and the perception of pain intensity was stronger in adults than in children. More than 80% of adults, but only 1/3 of children chose the most desperate images when attempting to depict pain. The quality of life, probably influenced by previous anguishing pain experiences, resulted good only in seven out of 21 adults, but in fifteen out of 19 children, and no child considered it poor. Conclusions. This difference suggests that the longer the duration of the disease, the more negative the evaluation of the experience in sickle-cell patients. The small sample size limits the generalization of our findings. More developmentally oriented studies with appropriate diagnostic instruments are warranted.