Campbell Claudia M, Moscou-Jackson Gyasi, Carroll C Patrick, Kiley Kasey, Haywood Carlton, Lanzkron Sophie, Hand Matthew, Edwards Robert R, Haythornthwaite Jennifer A
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Johns Hopkins University School of Nursing, Baltimore, Maryland.
J Pain. 2016 May;17(5):617-27. doi: 10.1016/j.jpain.2016.01.475. Epub 2016 Feb 16.
Central sensitization (CS), nociceptive hyperexcitability known to amplify and maintain clinical pain, has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. Recent evidence suggests that it may explain differences in the symptom experience of individuals with sickle cell disease (SCD). Quantitative sensory testing (QST) can be used to examine CS and identify individuals who may have a heightened CS profile. The present study categorized patients with SCD on the basis of QST responses into a high or low CS phenotype and compared these groups according to measures of clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity. Eighty-three adult patients with SCD completed QST, questionnaires, and daily sleep and pain diaries over a 3-month period, weekly phone calls for 3 months, and monthly phone calls for 12 months. Patients were divided into CS groups (ie, no/low CS [n = 17] vs high CS [n = 21]), on the basis of thermal and mechanical temporal summation and aftersensations, which were norm-referenced to 47 healthy control subjects. High CS subjects reported more clinical pain, vaso-occlusive crises, catastrophizing, and negative mood, and poorer sleep continuity (Ps < .05) over the 18-month follow-up period. Future analyses should investigate whether psychosocial disturbances and sleep mediate the relationship between CS and pain outcomes.
In general, SCD patients with greater CS had more clinical pain, more crises, worse sleep, and more psychosocial disturbances compared with the low CS group.
中枢敏化（CS），即已知会放大并维持临床疼痛的伤害性超兴奋性，已被确定为多种慢性疼痛病症中维持疼痛的主要元凶。最近的证据表明，它可能解释了镰状细胞病（SCD）患者症状体验的差异。定量感觉测试（QST）可用于检查中枢敏化并识别可能具有较高中枢敏化特征的个体。本研究根据QST反应将SCD患者分为高或低中枢敏化表型，并根据临床疼痛、血管闭塞性危机、心理社会因素和睡眠连续性指标对这些组进行比较。83名成年SCD患者在3个月内完成了QST、问卷调查以及每日睡眠和疼痛日记，在3个月内每周进行电话随访，在12个月内每月进行电话随访。根据热和机械性时间总和以及后感觉，将患者分为中枢敏化组（即无/低中枢敏化[n = 17]与高中枢敏化[n = 21]），这些指标以47名健康对照者为参照标准进行了标准化。在18个月的随访期内，高中枢敏化受试者报告了更多的临床疼痛、血管闭塞性危机、灾难化思维和负面情绪，以及更差的睡眠连续性（P值<0.05）。未来的分析应调查心理社会干扰和睡眠是否介导了中枢敏化与疼痛结果之间的关系。
总体而言，与低中枢敏化组相比，中枢敏化程度较高的SCD患者有更多的临床疼痛、更多的危机、更差的睡眠和更多的心理社会干扰。
