Garcia-Hernandez Ailyn, de la Coba Pablo, Martinez-Triana Raúl J, Reyes Del Paso Gustavo A
Department of Psychology, University of Jaén, Jaén, Spain.
Department of Psychology and Anthropology, University of Extremadura, Avenida de la Universidad, Cáceres, Spain.
J Eval Clin Pract. 2025 Feb;31(1):e14101. doi: 10.1111/jep.14101. Epub 2024 Jul 18.
Responses to experimental pain have suggested central and peripheral sensitisation in adult patients with sickle cell disease (SCD). Recent studies have proposed an algometry-derived dynamic measure of pain sensitisation, slowly repeated evoked pain (SREP), which is useful in the discrimination of painful conditions related to central sensitisation. Pain and fatigue are two symptoms that affect the general functioning of patients with SCD most significantly, however, research about experimental dynamic pain measures and their relation to the main symptoms of SCD (pain and fatigue) is still scarce.
This preliminary study aimed to test the utility of the SREP protocol for detecting pain sensitisation in patients with SCD, and to evaluate the associations of pain sensitisation, pain threshold, and pain tolerance with the main clinical symptoms of SCD, pain and fatigue.
Twenty-two female outpatients with SCD and 20 healthy women participated. Pain threshold, pain tolerance, and pain sensitisation were assessed by algometry in the fingernail. Clinical pain, fatigue, anxiety, depression and pain catastrophizing were evaluated.
No group differences were found in pain threshold and tolerance. However, using the SREP protocol, pain sensitisation was greater in patients than in healthy participants, even after controlling for psychological variables and body mass index. Pain threshold and tolerance were inversely associated with fatigue levels in the SCD group, with pain tolerance being the main predictor.
Pain threshold and tolerance did not discriminate between patients and healthy individuals, but were useful for predicting fatigue severity in SCD. The SREP protocol provides a useful dynamic measure of pain for the discrimination and detection of enhanced pain sensitisation in patients with SCD, which could contribute to more personalised pain evaluations and treatment for these patients.
对实验性疼痛的反应表明，成年镰状细胞病（SCD）患者存在中枢和外周敏化。最近的研究提出了一种通过压力痛觉测定法得出的疼痛敏化动态测量指标，即缓慢重复诱发疼痛（SREP），它有助于区分与中枢敏化相关的疼痛状况。疼痛和疲劳是对SCD患者总体功能影响最为显著的两种症状，然而，关于实验性动态疼痛测量指标及其与SCD主要症状（疼痛和疲劳）之间关系的研究仍然很少。
这项初步研究旨在测试SREP方案在检测SCD患者疼痛敏化方面的效用，并评估疼痛敏化、痛阈和疼痛耐受力与SCD主要临床症状（疼痛和疲劳）之间的关联。
22名患有SCD的女性门诊患者和20名健康女性参与了研究。通过压力痛觉测定法评估指甲处的痛阈、疼痛耐受力和疼痛敏化。评估临床疼痛、疲劳、焦虑、抑郁和疼痛灾难化情况。
在痛阈和疼痛耐受力方面未发现组间差异。然而，使用SREP方案，即使在控制了心理变量和体重指数之后，患者的疼痛敏化程度仍高于健康参与者。在SCD组中，痛阈和疼痛耐受力与疲劳水平呈负相关，疼痛耐受力是主要预测因素。
痛阈和疼痛耐受力无法区分患者和健康个体，但有助于预测SCD患者的疲劳严重程度。SREP方案为区分和检测SCD患者增强的疼痛敏化提供了一种有用的动态疼痛测量指标，这可能有助于为这些患者进行更个性化的疼痛评估和治疗。
