The use of abstract animations and a graphical body image for assessing pain outcomes among adults with sickle cell disease

Julia A O'Brien; Charles R Jonassaint; Ektha Parchuri; Christina M Lalama; Sherif M Badawy; Megan E Hamm; Jennifer N Stinson; Chitra Lalloo; C Patrick Carroll; Santosh L Saraf; Victor R Gordeuk; Robert M Cronin; Nirmish Shah; Sophie M Lanzkron; Darla Liles; Cassandra Trimnell; Lakiea Bailey; Raymona Lawrence; Leshana Saint Jean; Michael DeBaun; Laura M De Castro; Tonya M Palermo; Kaleab Z Abebe

doi:10.1016/j.jpain.2024.104720

The use of abstract animations and a graphical body image for assessing pain outcomes among adults with sickle cell disease

J Pain. 2024 Oct 22:26:104720. doi: 10.1016/j.jpain.2024.104720. Online ahead of print.

Authors

Julia A O'Brien¹, Charles R Jonassaint², Ektha Parchuri³, Christina M Lalama³, Sherif M Badawy⁴, Megan E Hamm³, Jennifer N Stinson⁵, Chitra Lalloo⁶, C Patrick Carroll⁷, Santosh L Saraf⁸, Victor R Gordeuk⁸, Robert M Cronin⁹, Nirmish Shah¹⁰, Sophie M Lanzkron⁷, Darla Liles¹¹, Cassandra Trimnell¹², Lakiea Bailey¹³, Raymona Lawrence¹⁴, Leshana Saint Jean¹⁵, Michael DeBaun¹⁵, Laura M De Castro³, Tonya M Palermo¹⁶, Kaleab Z Abebe³

Affiliations

¹ Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA.
² Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: [email protected].
³ Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
⁴ Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
⁵ Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada; Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
⁶ Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada; Institute for Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada.
⁷ Johns Hopkins Sickle Cell Center for Adults, Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁸ Sickle Cell Center, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
⁹ Department of Internal Medicine, The Ohio State University, Columbus, OH, USA.
¹⁰ Sickle Cell Transition Program, Division of Hematology, Division of Pediatric Hematology/Oncology, Duke University, Durham, NC, USA.
¹¹ Department of Internal Medicine, East Carolina University, Greenville, NC, USA.
¹² Sickle Cell 101, San Jose, CA, USA.
¹³ Sickle Cell Community Consortium, Atlanta, GA, USA.
¹⁴ Jiann Ping Hsu College of Public Health, Georgia Southern University, Savannah, GA, USA.
¹⁵ Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁶ Department of Anesthesiology & Pain Medicine, University of Washington, and Seattle Children's Research Institute, Seattle, WA, USA.

PMID: 39447944
DOI: 10.1016/j.jpain.2024.104720

Abstract

Painimation, a novel digital pain assessment tool, allows patients to communicate their pain quality, intensity, and location using abstract animations (painimations) and a paintable body image. This study determined the construct validity of painimations and body image measures by testing correlations with validated pain outcomes in adults with sickle cell disease (SCD). Analyses used baseline data from a multisite randomized trial of 359 adults with SCD and chronic pain. Participants completed questionnaires on demographics, pain severity, frequency and interference, catastrophizing, opioid use, mood and quality of life, plus the Painimation app. Participants were categorized by selected painimations, and were split into groups based on the proportion of painted body image. Potential confounding was evaluated by age, gender, race, education, disability, site, depression, and anxiety. The 'shooting' painimation was strongly associated with daily pain intensity, pain interference, frequency, and severity. 'Electrifying' was associated with daily pain and opioid misuse, while greater body area in pain correlated with worse outcomes across all pain measures. Both painimations and body image measures correlated with validated pain outcomes, quality of life and mental health measures. This demonstrates animations and body image data can assess SCD pain severity, potentially with more accuracy than a 0-10 scale. Future research will explore whether Painimation can differentiate biological and psychosocial pain components. PERSPECTIVE: This article presents the preliminary construct validity of Painimation in SCD by examining the associations of "painimations" and body area image data with daily e-diary and traditional self-report pain outcomes.

Keywords: Ecological momentary assessment; Mental health; Pain; Sickle cell disease; eHealth; mHealth.