College of Pharmacy, Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, IL, United States.
Med Hypotheses. 2011 Oct;77(4):491-3. doi: 10.1016/j.mehy.2011.06.018. Epub 2011 Jul 16.
Less than 20 years after Herrick described the first case, the cold was proposed as having a role in precipitating pain in sickle cell disease. Numerous publications focus on weather changes, in particular exposure to the cold, and their association with vaso-occlusive (painful) episodes. Whereas several theories have been proposed to explain the association, a plausible hypothesis based on our current understanding of the pathophysiology of pain has not been offered. We hypothesize that the pain evoked by these weather changes are allodyinic (pain with stimulus not typically painful) and hyperalgesic (heightened pain with painful stimulus) responses due to the presence of neuropathic pain. This hypothesis represents a paradigm shift in understanding, as well as explaining at least some of the pain experience in sickle cell disease, and should be the impetus to further determine the characteristics of those patients who develop allodynia and hyperalgesia to cold weather. Whereas some researchers have suggested that those with sickle cell disease may have neuropathic pain, including a report from our own ongoing study [1], it has not been well accepted nor has it been applied in understanding pain associated with sickle cell disease. The conceptual shift and new understanding is important to develop preventive strategies, apply pain therapies new to the sickle cell population, and view pain in sickle cell disease in the context of a chronic disease.
在 Herrick 描述首例病例不到 20 年后，人们提出寒冷可能在镰状细胞病引起疼痛中起作用。许多出版物都集中在气候变化上，特别是暴露在寒冷中，以及它们与血管阻塞（疼痛）发作的关联。尽管已经提出了几种理论来解释这种关联，但基于我们目前对疼痛病理生理学的理解，尚未提出合理的假设。我们假设，由于存在神经病理性疼痛，这些天气变化引起的疼痛都是痛觉过敏（有刺激时的疼痛）和痛觉过敏（疼痛刺激时的疼痛加剧）反应。这一假设代表了理解上的范式转变，至少可以解释镰状细胞病中一些疼痛的体验，并且应该是进一步确定那些对寒冷天气产生痛觉过敏和痛觉过敏的患者特征的动力。虽然一些研究人员认为镰状细胞病患者可能存在神经病理性疼痛，包括我们自己正在进行的研究报告[1]，但这并未得到广泛接受，也未应用于理解镰状细胞病相关疼痛。概念转变和新的理解对于制定预防策略、将新的疼痛疗法应用于镰状细胞人群以及从慢性病的角度看待镰状细胞病的疼痛都很重要。
