Oudin Doglioni D, Couette M, Forté S, Galacteros F, Gay M-C
Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Université Savoie Mont-Blanc, Grenoble, France.
Intensive Care Unit, Teaching Hospital Henri Mondor, Créteil, France.
Eur J Pain. 2025 Jul;29(6):e70059. doi: 10.1002/ejp.70059.
Sickle cell disease (SCD) is the most prevalent inherited haemoglobinopathy characterised by chronic pain with acute painful episodes due to vaso-occlusion. The effective management of pain by adults with SCD influences their health outcomes. Opioids remain essential for most pain syndromes, but non-pharmacological interventions are preferred for daily pain due to the risk of addiction. However, their effectiveness is variable. Understanding the underlying processes associated with pain is crucial for developing more effective non-pharmacological strategies. This study aimed to enhance comprehension of the pain mechanisms in SCD to identify potential areas of action for effective non-pharmacological interventions.
An evaluation was conducted on the severity and interference of pain, pain-related cognitions and emotions. We used network analysis to simultaneously examine the intricate relationships between these variables.
A pain intensity exceeding 4 at a steady state distinguishes a subgroup at elevated risk of negative pain-related emotions and cognitions. The network analysis revealed intricate interconnections, with three distinct subgroups of variables mimicking the Neuromatrix model (cognitive-evaluative, motivational-affective and sensory-discriminative subgroups). The derived directed acyclic graph suggests potential mechanisms between these three subgroups, with catastrophising having a pivotal role.
This study extends previous research by providing a comprehensive network analysis of pain-related variables in SCD, offering novel insights into the complex interplay between pain experience, cognitions and emotions. These findings have important clinical implications, as they suggest that targeting dysfunctional pain cognitions and/or negative emotions may be beneficial for improving pain management and quality of life in SCD.
This study was the first to use network analyses to understand simultaneously multiple relationships between variables referring to pain, and pain-related negative emotions and cognitions in adults with SCD. Findings, providing support to the Neuromatrix model, offer novel insight to better understand pain and the associated negative emotions and cognition in SCD. The derived directed acyclic graph explored potential underlying psychological processes associated with pain that could be specifically targeted by future effective psychological interventions.
镰状细胞病（SCD）是最常见的遗传性血红蛋白病，其特征为慢性疼痛，并因血管阻塞而出现急性疼痛发作。成年SCD患者对疼痛的有效管理会影响其健康结局。阿片类药物对大多数疼痛综合征仍然至关重要，但由于存在成瘾风险，非药物干预措施更适合日常疼痛。然而，其效果存在差异。了解与疼痛相关的潜在过程对于制定更有效的非药物策略至关重要。本研究旨在加深对SCD疼痛机制的理解，以确定有效非药物干预措施的潜在作用领域。
对疼痛的严重程度和干扰、与疼痛相关的认知和情绪进行了评估。我们使用网络分析来同时检查这些变量之间的复杂关系。
稳态时疼痛强度超过4可区分出一个亚组，该亚组出现与疼痛相关的负面情绪和认知的风险较高。网络分析揭示了复杂的相互联系，有三个不同的变量亚组，类似于神经矩阵模型（认知评估、动机情感和感觉辨别亚组）。推导的有向无环图表明了这三个亚组之间的潜在机制，其中灾难化思维起关键作用。
本研究通过对SCD中与疼痛相关的变量进行全面的网络分析，扩展了先前的研究，为疼痛体验、认知和情绪之间的复杂相互作用提供了新的见解。这些发现具有重要的临床意义，因为它们表明针对功能失调的疼痛认知和/或负面情绪可能有利于改善SCD患者的疼痛管理和生活质量。
本研究首次使用网络分析来同时理解SCD成年患者中与疼痛、与疼痛相关的负面情绪和认知有关的变量之间的多种关系。研究结果为神经矩阵模型提供了支持，为更好地理解SCD中的疼痛及相关负面情绪和认知提供了新的见解。推导的有向无环图探索了与疼痛相关的潜在心理过程，未来有效的心理干预措施可针对这些过程。
