Ramprakash Stalin, Fishman Daniel
Department of General Paediatrics, Luton and Dunstable Hospital, Luton, UK Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital, London, UK.
Department of Rheumatology, Luton and Dunstable Hospital, Luton, UK.
BMJ Case Rep. 2015 Oct 1;2015:bcr2015211850. doi: 10.1136/bcr-2015-211850.
Juvenile fibromyalgia in children with sickle cell disease has not been reported in the literature. We report an adolescent patient with sickle cell whose pain symptoms progressed from having recurrent acute sickle cell pain crisis episodes to a chronic pain syndrome over several years. He was eventually diagnosed with juvenile fibromyalgia based on the clinical history and myofascial tender points and his pain symptoms responded better to multidisciplinary strategies for chronic fibromyalgia pain. Chronic pain in sickle cell disease is an area of poor research, and in addition there is inconsistency in the definition of chronic pain in sickle cell disease. Central sensitisation to pain is shown to occur after recurrent painful stimuli in a genetically vulnerable individual. In a chronic pain condition such as fibromyalgia central sensitisation is thought to play a key role. Fibromyalgia should be considered as one of the main differential diagnosis in any sickle cell patient with chronic pain.
镰状细胞病患儿的青少年纤维肌痛在文献中尚未见报道。我们报告一名患有镰状细胞病的青少年患者，其疼痛症状在数年间从反复出现急性镰状细胞疼痛危象发展为慢性疼痛综合征。根据临床病史和肌筋膜压痛点，他最终被诊断为青少年纤维肌痛，并且他的疼痛症状对慢性纤维肌痛疼痛的多学科治疗策略反应更好。镰状细胞病中的慢性疼痛是一个研究较少的领域，此外，镰状细胞病中慢性疼痛的定义也不一致。在遗传易感性个体中，反复的疼痛刺激后会出现对疼痛的中枢敏化。在纤维肌痛等慢性疼痛疾病中，中枢敏化被认为起关键作用。对于任何患有慢性疼痛的镰状细胞病患者，纤维肌痛都应被视为主要的鉴别诊断之一。
