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Children and adolescents with sickle cell disease have worse cold and mechanical hypersensitivity during acute painful events - 11/2/2019

Pain 2019; 160: 407-16


Sickle cell disease (SCD) pain associates with cold temperature and touch. Patients and murine models with SCD have baseline thermal and mechanical pain. In SCD mice, the baseline hypersensitivity is exacerbated by experimental vaso-occlusive crises. These authors hypothesized that patients with SCD will similarly experience increased hypersensitivity to thermal and mechanical stimuli during acute painful events compared with baseline health.



The authors conducted a prospective study of 24 patients with SCD, aged 7 to 19 years. Patients underwent quantitative sensory testing to thermal (cold/heat) and mechanical stimuli on the thenar eminence of the non-dominant hand (glabrous skin) and the lateral dorsum of the foot (hairy skin) during baseline health and within 48 hours of hospitalization for acute pain. Primary outcomes were changes in: (1) cold pain threshold (°C), (2) heat pain threshold (°C) and (3) mechanical pain threshold (g). The median age was 10.5 (interquartile range [IQR] 9-14.8) years, 67% were females and 92% were on hydroxyurea.



Patients with SCD had increased cold pain sensitivity in the hand during hospitalisation compared with baseline (25.2°C [IQR 18.4-27.5°C] vs 21.3°C [IQR 4.9-26.2°C]; p=0.011) and increased mechanical pain sensitivity in the foot during hospitalisation (0.32 g [IQR 0.09-1.1 g] versus 1.7 g [IQR 0.4-8.3 g]; p=0.003). There were no differences in heat pain sensitivity. The increased cold (p=0.02) and mechanical (p=0.0016) pain sensitivity during hospitalisation persisted after adjusting for age, gender, hydroxyurea use, opioid consumption and numerical pain score.



The authors conclude that cold and mechanical pain is significantly worse during an acute SCD painful event as compared with baseline health in patients with SCD.

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