Jacob Eufemia, Chan Victoria Wong, Hodge Christopher, Zeltzer Lonnie, Zurakowski David, Sethna Navil F
*UCLA School of Nursing †Pediatric Pain and Comfort Care Program ‡Department of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA §Harvard Medical School, Boston Children's Hospital ∥Department of Anesthesia, Perioperative and Pain Medicine, Mayo Family Pediatric Pain Rehabilitation Center, Boston, MA.
J Pediatr Hematol Oncol. 2015 Apr;37(3):185-9. doi: 10.1097/MPH.0000000000000214.
Very little is known about pain processing in sickle cell disease (SCD). We examined the mechanical and thermal sensory patterns in children with SCD. Children ages 10 to 17 years (n = 48; mean 13.7 ± 2.0 y; 22 females) participated in quantitative sensory testing (QST) procedures and completed a quality of life (PedsQL) and anxiety and depression scale (RCADS). Thirteen children showed evidence of abnormal pain processing, indicated by decreased sensitivity to heat or cold sensations (hypoesthesia), and pain experienced with nonpainful stimuli (allodynia). Pain ratings associated with cold and warm sensations were significantly higher in the subgroup with abnormal QST compared with the 35 SCD children with normal QST (P = 0.01 and P < 0.0001, respectively). The presence of hypoesthesia and allodynia in children with SCD may represent abnormal changes in the peripheral and central nervous system. Clinicians need to be aware that sickle cell pain may not only be inflammatory or ischemic secondary to vasoocclusion and hypoxia, but may also be neuropathic secondary to nerve injury or nerve dysfunction. Neuropathic pain in SCD may be the result of tissue damage after vaso-occlusion in neural tissues, whether peripherally or centrally. Future studies are needed to determine the presence of neuropathic pain in children with SCD.
关于镰状细胞病（SCD）的疼痛处理，我们所知甚少。我们研究了SCD患儿的机械性和热感觉模式。10至17岁的儿童（n = 48；平均13.7±2.0岁；22名女性）参与了定量感觉测试（QST）程序，并完成了生活质量（儿童生活质量量表）和焦虑抑郁量表（儿童焦虑抑郁量表）。13名儿童表现出疼痛处理异常的迹象，表现为对热或冷感觉的敏感性降低（感觉减退），以及对非疼痛刺激产生疼痛（异常性疼痛）。与正常QST的35名SCD儿童相比，QST异常亚组中与冷和热感觉相关的疼痛评分显著更高（分别为P = 0.01和P < 0.0001）。SCD患儿中感觉减退和异常性疼痛的存在可能代表外周和中枢神经系统的异常变化。临床医生需要意识到，镰状细胞疼痛可能不仅是继发于血管阻塞和缺氧的炎症性或缺血性疼痛，还可能是继发于神经损伤或神经功能障碍的神经性疼痛。SCD中的神经性疼痛可能是神经组织中血管阻塞后组织损伤的结果，无论是外周还是中枢。需要进一步的研究来确定SCD患儿中神经性疼痛的存在情况。
