Inhaled nitric oxide for treating pain crises in people with sickle cell disease

Aboursheid, Tarek; Albaroudi, Omar; Alahdab, Fares

doi:10.1002/14651858.cd011808.pub2

Cited by 8 publications

(8 citation statements)

References 30 publications

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“…Indeed, nitrous oxide is not described as a treatment for neuropathic pain per se, but it does have an action on NMDA receptors [ 27 ] and, therefore, is susceptible to action on the central sensitization mechanisms. Its usefulness in the management of VOC has been demonstrated to be analgesic and anxiolytic [ 28 ], but could also have interesting complementary effects—notably, anti-neuropathic effects—which remain to be studied in the context of VOC. The effectiveness of drugs usually used for neuropathic pain, including gabapentin, pregabalin, amitriptyline, serotonin-noradrenaline reuptake inhibitors (SNRIs), and tricyclic antidepressants, has not been firmly established in SCD patients, let alone in SCD children.…”

Section: Discussionmentioning

confidence: 99%

Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

et al. 2021

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The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient’s age, sex, and clinical presentation.

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Section: Discussionmentioning

confidence: 99%

Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

et al. 2021

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“…In addition to its role in vascular tone, blood flow and adhesion, • NO is known to possess antioxidant properties. Moreover, inhalation of exogenous • NO, can be used to reduce pain in SCD patients with pulmonary hypertension [ 86 ] and microvascular occlusion in different parts of the body, but controversial results are reported by randomized trials (NCT00094887) [ 163 ].…”

Section: Antioxidant Therapy For Scdmentioning

confidence: 99%

Sickle Cell Disease: Role of Oxidative Stress and Antioxidant Therapy

et al. 2021

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Sickle cell disease (SCD) is the most common hereditary disorder of hemoglobin (Hb), which affects approximately a million people worldwide. It is characterized by a single nucleotide substitution in the β-globin gene, leading to the production of abnormal sickle hemoglobin (HbS) with multi-system consequences. HbS polymerization is the primary event in SCD. Repeated polymerization and depolymerization of Hb causes oxidative stress that plays a key role in the pathophysiology of hemolysis, vessel occlusion and the following organ damage in sickle cell patients. For this reason, reactive oxidizing species and the (end)-products of their oxidative reactions have been proposed as markers of both tissue pro-oxidant status and disease severity. Although more studies are needed to clarify their role, antioxidant agents have been shown to be effective in reducing pathological consequences of the disease by preventing oxidative damage in SCD, i.e., by decreasing the oxidant formation or repairing the induced damage. An improved understanding of oxidative stress will lead to targeted antioxidant therapies that should prevent or delay the development of organ complications in this patient population.

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“…NO availability can be derived from inhaled NO during VOC or use of agents such as l -citrulline [ 72 ] and l -arginine [ 73 ], both are substrates in the NO cycle. Clinical studies using inhaled NO monotherapy to treat VOC, however, did not find any obvious clinical benefits [ 74 , 75 ].…”

Section: Introductionmentioning

confidence: 99%

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

et al. 2021

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Painful vaso-occlusive crisis (VOC) remains the most common reason for presenting to the Emergency Department and hospitalization in patients with sickle cell disease (SCD). Although two new agents have been approved by the Food and Drug Administration for treating SCD, they both target to reduce the frequency of VOC. Results from studies investigating various approaches to treat and shorten VOC have so far been generally disappointing. In this paper, we will summarize the complex pathophysiology and downstream events of VOC and discuss the likely reasons for the disappointing results using monotherapy. We will put forward the rationale for exploring some of the currently available agents to either protect erythrocytes un-involved in the hemoglobin polymerization process from sickling induced by the secondary events, or a multipronged combination approach that targets the complex downstream pathways of VOC.

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Inhaled nitric oxide for treating pain crises in people with sickle cell disease

Cited by 8 publications

References 30 publications

Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis

Sickle Cell Disease: Role of Oxidative Stress and Antioxidant Therapy

Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events

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