Pain, Fatigue Not Associated With Neurocognitive Performance in Adolescents With SCD

Pain and fatigue were not found to be associated with neurocognitive performance in adolscents and young adults who had sickle cell disease (SCD), according to a study published in Pediatric Blood & Cancer. The findings imply that clinicians do not need to weigh chronic pain and fatigue when considering neurocognitive test data.

SCD is a disorder characterized by misshapen hemoglobin molecules. Approximately 100,000 individuals in the United States are thought to be living with SCD. Chronic pain and fatigue have been known to be complications of SCD, with neurocognitive functioning potentially affected by these symptoms. The study aimed to “examine the relationship between pain and fatigue with neurocognitive functioning by utilizing performance-based measures (gold standard measures) of neurocognitive functioning in adolescents and young adults with SCD.”

The Sickle Cell Clinical Research Intervention Program (SCCRIP), a longitudinal lifetime cohort study, was used to find participants for the study. The SCCRIP included neurocognitive assessments that were performed every 4 years for individuals aged between 8 and 24 years and every 6 years for adults. This study featured individuals who were tested at either late adolescence between the ages of 16 and 18 or early adulthood between the ages of 20 and 25.

The self-report version of the Pediatric Quality of Life Inventory (PEDsQL) Multidimensional Fatigue Scale was administered to all participants, with the Total Fatigue scores used for correlation analyses. Pain severity was assessed using the PEDsQL SCD Module: Pain and Hurt Scale.

Individuals could be included if they had completed the PEDsQL modules within a year of completing measures of neurocognitive performance. These included the Wechsler Abbreviated Scale of Intelligence–Second Edition to obtain an IQ score and the Wechsler Adult Intelligence Scale–Fourth Edition or Wechsler Intelligence Scale for Children–Fourth Edition to assess memory and processing speed.

There were a total of 106 patients included in the study who had a median age of 17, were 54% female, and all patients were Black.

The bivariate correlation analyses found no significant association between self-reported fatigue and IQ (r_s, –0.031), working memory (r_s, 0.161), or processing speed (r, 0.010). No relationships were found between self-reported pain and IQ (r, –0.033), working memory (r_s, 0.133), or processing speed (r, 0.030).

The bivariate partial correlation analyses had similar results when controlling for sickle genotype and age. No significant relationships were found between self-reported fatigue and IQ (r, –0.053), working memory (rs, –0.163), or processing speed (r, –0.007). Relationships were also not found between self-reported pain and IQ (r, –0.044), working memory (r_s, 0.128), or processing speed (r, 0.045).

There were 2 limitations of note. First, the self-reported pain and fatigue were not assessed at the same time as neurocognitive performance. Also, pain medication use was not evaluated in the participants.

The researchers concluded that additional research into the relationship between pain and fatigue and SCD is warranted but that these results suggest that “clinicians may not need to weigh chronic pain and fatigue as significant contributory factors when interpreting neurocognitive test data.”

Reference

Semko JH, Longoria J, Porter J, et al. Examining the influence of pain and fatigue on neurocognitive functioning in adolescents and young adults with sickle cell disease. Pediatr Blood Cancer. Published online August 10, 2023. doi:10.1002/pbc.30621