Departments of ‡Pediatrics, Division of Hematology/Oncology *Anesthesia and Pain Medicine, the Hospital for Sick Children §Department of Anaesthesia, Faculty of Medicine, University of Toronto, ON, Canada †Department of Anaesthesia, Faculty of Medicine, University College Cork, Cork, Ireland.
Clin J Pain. 2014 Mar;30(3):244-50. doi: 10.1097/AJP.0b013e318292a38e.
OBJECTIVES: Early tissue injury and recurrent pain in sickle cell disease (SCD) may alter pain and sensory processing. In this study, we evaluate thermal pain and sensory processing for 27 children aged 10.3 to 18.3 years with SCD and 28 African-American control patients. MATERIALS AND METHODS: Outcome measures included heat and cold detection thresholds, heat and cold pain thresholds, and thermal perceptual sensitization at the volar surface of the dominant forearm and thenar eminence of the nondominant hand. RESULTS: Children with SCD were less sensitive to heat detection (P=0.006) and cold detection (P=0.015) stimuli at the thenar eminence compared with controls. At the forearm, no difference was found between groups for cold (P=0.58) or heat (P=0.07) detection thresholds. Children with SCD had increased sensitivity to cold pain at the forearm (P=0.03) compared with controls, but not when measured at the thenar eminence (P=0.084). There was no evidence that children with SCD had altered heat pain thresholds compared with controls. There was no difference between groups for perceptual sensitization at the thenar eminence (41% vs. 39%) (χ=0.15, P>0.1) or at the forearm (30% vs. 36%) (χ=0.23, P>0.5). DISCUSSION: Three of ten quantitative sensory tests were found to differ between groups. These results suggest that SCD may influence pain and sensory processing in children, but our interpretation is necessarily cautious. Due to the small differences in measures found between groups, further investigation is required to confirm our findings. If confirmed, the development of population-specific reference standards for quantitative sensory testing may emerge as a useful clinical tool for pain physicians in identifying and quantifying pain and sensory processing in children with SCD.
目的:镰状细胞病(SCD)患者早期组织损伤和复发性疼痛可能改变疼痛和感觉处理。本研究评估了 27 名年龄在 10.3 至 18.3 岁的 SCD 患儿和 28 名非裔美国对照组患者的热痛觉和感觉处理。
材料和方法:结果测量包括手掌和非优势手大鱼际的热觉和冷觉检测阈值、热痛觉和冷痛觉阈值以及热感觉敏化。
结果:与对照组相比,SCD 患儿手掌和大鱼际的热觉(P=0.006)和冷觉(P=0.015)检测阈值均降低。两组之间在冷觉(P=0.58)或热觉(P=0.07)检测阈值上无差异。与对照组相比,SCD 患儿前臂的冷痛觉阈值增加(P=0.03),但在大鱼际无差异(P=0.084)。与对照组相比,SCD 患儿的热痛觉阈值无差异。与对照组相比,大鱼际(41%比 39%)(χ=0.15,P>0.1)和前臂(30%比 36%)(χ=0.23,P>0.5)的感觉敏化差异无统计学意义。
讨论:十种定量感觉测试中有三种在组间存在差异。这些结果表明 SCD 可能影响儿童的疼痛和感觉处理,但我们的解释必须谨慎。由于组间测量值差异较小,需要进一步研究来证实我们的发现。如果得到证实,为定量感觉测试制定特定人群的参考标准可能成为疼痛医生识别和量化 SCD 儿童疼痛和感觉处理的有用临床工具。
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