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Psychological Characteristics and Pain Frequency Are Associated With Experimental Pain Sensitivity in Pediatric Patients With Sickle Cell Disease

  • Nitya Bakshi
    Affiliations
    Division of Pediatric Hematology-Oncology-Bone Marrow Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

    Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Ines Lukombo
    Affiliations
    Division of Pediatric Hematology-Oncology-Bone Marrow Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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  • Helen Shnol
    Affiliations
    Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Inna Belfer
    Affiliations
    Department of Anesthesiology, University of Pittsburgh, Pittsburgh, Pennsylvania
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  • Lakshmanan Krishnamurti
    Correspondence
    Address reprint requests to Lakshmanan Krishnamurti, MD, Emory University, Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University, 2015 Uppergate Drive, Atlanta, GA; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA 30322.
    Affiliations
    Division of Pediatric Hematology-Oncology-Bone Marrow Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

    Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
    Search for articles by this author

      Highlights

      • Pain sensitivity in sickle cell disease (SCD) is influenced by psychological factors.
      • Frequency of pain episodes also influences pain sensitivity in SCD.
      • Age- and gender-based normative data on pain sensitivity should be used to define impaired pain sensitivity in SCD.

      Abstract

      Sickle cell disease (SCD) is associated with episodes of severe vaso-occlusive pain beginning in infancy with a subset of patients with SCD transitioning to chronic pain. Response to experimental pain using quantitative sensory testing in these patients suggests altered pain processing. The objectives of this study were to characterize sensitivity to multiple modalities of experimental pain stimuli and to interrogate the relationship of psychological covariates, clinical pain burden, and pain-related outcomes to experimental pain sensitivity in children with SCD compared with healthy individuals of similar age and sex. Cross-sectional assessments of psychological characteristics were performed, and quantitative sensory testing methods were used to measure experimental pain sensitivity in children age 8 to 21 years. Anxiety, depressive symptoms, catastrophizing, and somatization were found to be associated with increased sensitivity to experimental pain stimuli. Increased frequency of painful episodes in SCD was associated with decreased sensitivity to heat pain and decreased mechanical temporal summation. These data suggest that careful consideration be given to psychological factors, age, sex, and clinical burden of pain when studying response to experimental pain in SCD.

      Perspective

      In this study of patients with SCD, a condition associated with recurrent acute or chronic pain, psychological factors such as depression, anxiety, and catastrophizing are associated with increased sensitivity to experimental pain stimuli. Further study is need to delineate the role of these factors in chronic SCD pain.

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