TY - JOUR
T1 - Central sensitization associated with low fetal hemoglobin levels in adults with sickle cell anemia
AU - Darbari, Deepika S.
AU - Vaughan, Kathleen J.
AU - Roskom, Katherine
AU - Seamon, Cassie
AU - Diaw, Lena
AU - Quinn, Meghan
AU - Conrey, Anna
AU - Schechter, Alan N.
AU - Haythornthwaite, Jennifer A.
AU - Waclawiw, Myron A.
AU - Wallen, Gwenyth R.
AU - Belfer, Inna
AU - Taylor, James G.
N1 - Funding Information:
We thank Dr. Steve Harte of the Chronic Pain and Fatigue Research Center in the Department of Anesthesiology at the University of Michigan for providing the hydraulic pressure device for use in this study. We also thank Stephanie Housel for expert protocol management. Finally, we thank the intramural program of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for the generous donation of space and nursing support in the Clinical Center Metabolic Unit to complete this study. This work was supported by the NHLBI Intramural Research program, National Institutes of Health (1 ZIA HL006160 05), an NHLBI, National Institutes of Health Award (P50HL118006) and Howard University College of Medicine. DSD was partially supported by a contract from the National Institutes of Health (1 ZIA HL006160 05).
Funding Information:
We thank Dr. Steve Harte of the Chronic Pain and Fatigue Research Center in the Department of Anesthesiology at the University of Michigan for providing the hydraulic pressure device for use in this study. We also thank Stephanie Housel for expert protocol management. Finally, we thank the intramural program of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for the generous donation of space and nursing support in the Clinical Center Metabolic Unit to complete this study. This work was supported by the NHLBI Intramural Research program , National Institutes of Health ( 1 ZIA HL006160 05 ), an NHLBI , National Institutes of Health Award ( P50HL118006 ) and Howard University College of Medicine . DSD was partially supported by a contract from the National Institutes of Health ( 1 ZIA HL006160 05 ).
Publisher Copyright:
© 2017 Scandinavian Association for the Study of Pain
PY - 2017/10
Y1 - 2017/10
N2 - Background and aims Pain is the hallmark of sickle cell anemia (SCA), presenting as recurrent acute events or chronic pain. Central sensitization, or enhanced excitability of the central nervous system, alters pain processing and contributes to the maintenance of chronic pain. Individuals with SCA demonstrate enhanced sensitivity to painful stimuli however central mechanisms of pain have not been fully explored. We hypothesized that adults with SCA would show evidence of central sensitization as observed in other diseases of chronic pain. Methods We conducted a prospective study of static and dynamic quantitative sensory tests in 30 adults with SCA and 30 matched controls. Results Static thermal testing using cold stimuli showed lower pain thresholds (p = 0.04) and tolerance (p = 0.04) in sickle cell subjects, but not for heat. However, SCA subjects reported higher pain ratings with random heat pulses (p < 0.0001) and change in scores with temporal summation at the heat pain threshold (p = 0.002). Similarly, with the use of pressure pain stimuli, sickle cell subjects reported higher pain ratings (p = 0.04), but not higher pressure pain tolerance/thresholds or allodynia to light tactile stimuli. Temporal summation pain score changes using 2 pinprick probes (256 and 512 mN) were significantly greater (p = 0.004 and p = 0.008) with sickle cell, and delayed recovery was associated with lower fetal hemoglobin (p = 0.002 and 0.003). Conclusions Exaggerated temporal summation responses provide evidence of central sensitization in SCA. Implications The association with fetal hemoglobin suggests this known SCA modifier may have a therapeutic role in modulating central sensitization.
AB - Background and aims Pain is the hallmark of sickle cell anemia (SCA), presenting as recurrent acute events or chronic pain. Central sensitization, or enhanced excitability of the central nervous system, alters pain processing and contributes to the maintenance of chronic pain. Individuals with SCA demonstrate enhanced sensitivity to painful stimuli however central mechanisms of pain have not been fully explored. We hypothesized that adults with SCA would show evidence of central sensitization as observed in other diseases of chronic pain. Methods We conducted a prospective study of static and dynamic quantitative sensory tests in 30 adults with SCA and 30 matched controls. Results Static thermal testing using cold stimuli showed lower pain thresholds (p = 0.04) and tolerance (p = 0.04) in sickle cell subjects, but not for heat. However, SCA subjects reported higher pain ratings with random heat pulses (p < 0.0001) and change in scores with temporal summation at the heat pain threshold (p = 0.002). Similarly, with the use of pressure pain stimuli, sickle cell subjects reported higher pain ratings (p = 0.04), but not higher pressure pain tolerance/thresholds or allodynia to light tactile stimuli. Temporal summation pain score changes using 2 pinprick probes (256 and 512 mN) were significantly greater (p = 0.004 and p = 0.008) with sickle cell, and delayed recovery was associated with lower fetal hemoglobin (p = 0.002 and 0.003). Conclusions Exaggerated temporal summation responses provide evidence of central sensitization in SCA. Implications The association with fetal hemoglobin suggests this known SCA modifier may have a therapeutic role in modulating central sensitization.
KW - Central sensitization
KW - Fetal hemoglobin
KW - Pain
KW - Sickle cell anemia
KW - Temporal summation
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U2 - 10.1016/j.sjpain.2017.08.001
DO - 10.1016/j.sjpain.2017.08.001
M3 - Article
C2 - 28969994
AN - SCOPUS:85037827483
SN - 1877-8860
VL - 17
SP - 279
EP - 286
JO - Scandinavian Journal of Pain
JF - Scandinavian Journal of Pain
ER -