"Pain is Subjective": A Mixed-Methods Study of Provider Attitudes and Practices Regarding Pain Management in Sickle Cell Disease Across Three Countries.

Journal Article (Journal Article)


Sickle cell disease (SCD), an autosomal recessive blood disorder, affects millions of people worldwide. Approximately 80% of all cases are located in Africa.


This cross-national, interdisciplinary, collaborative study investigated provider attitudes about, and practices for, managing (assessing and treating) SCD pain.


We conducted 111 quantitative surveys and 52 semistructured interviews with health-care providers caring for adults and/or children with SCD in Cameroon, Jamaica, and the U.S.


Applying Haywood's scale for assessing SCD provider attitudes, the Jamaica site scored lower on "Negative Attitudes" than the Cameroonian and U.S. sites (P = 0.03 and <0.001, respectively). Providers at the U.S. site scored lower on "Positive Attitudes" than other sites (P < 0.001). "Red Flag" scores at the Cameroon sites were lower than at other sites (P < 0.001). Qualitative results across all three sites describe the current practices for SCD pain management, as well as the challenges surrounding management for health providers, including pain subjectivity, patient-provider and parent-provider relationships, resource availability, perceptions of drug-seeking behavior, and adherence. Providers also spontaneously offered solutions to reported challenges.


Overall, findings reveal that SCD provider attitudes toward their patients differed across sites, yet at all three sites, treating SCD pain is multidimensional.

Full Text

Duke Authors

Cited Authors

  • Stewart, KA; Parshad-Asnani, M; Wonkam, A; Bollinger, J; Ngo Bitoungui, V; Wonkam-Tingang, E; Powell, J; Desronvil, K; Benson, KRK; Clark, A; Katz, M; Martin, B; Peterseim, C; Williams, C; Young, N; Shah, N; Tanabe, P; Babyak, M; Royal, CDM

Published Date

  • March 2021

Published In

Volume / Issue

  • 61 / 3

Start / End Page

  • 474 - 487

PubMed ID

  • 32889040

Electronic International Standard Serial Number (EISSN)

  • 1873-6513

International Standard Serial Number (ISSN)

  • 0885-3924

Digital Object Identifier (DOI)

  • 10.1016/j.jpainsymman.2020.08.029


  • eng