Multimodal phenotyping and correlates of pain following hematopoietic cell transplant in children with sickle cell disease

Bakshi, Nitya; Astles, Rachel; Chou, Eric; Hurreh, Asha; Sinha, Cynthia; Sanders, Kolanda Ackey; Peddineni, Manasa; Gillespie, Scott; Keesari, Rohali; Krishnamurti, Lakshmanan

doi:10.1002/pbc.30046

Cited by 3 publications

(1 citation statement)

References 43 publications

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“…Transfusions, when chronic, may decrease hospitalization rates (115-117), but are not generally used to reduce pain. Even therapy with curative intent does not uniformly eradicate chronic (likely central) pain in individuals with SCD, but rather aborts acute nociceptive pain (118)(119)(120).…”

Section: Disease Modifiersmentioning

confidence: 99%

Precision, integrative medicine for pain management in sickle cell disease

Smith,

Valrie,

Jaja

et al. 2023

Front. Pain Res.

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Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack’s neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model.

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Section: Disease Modifiersmentioning

confidence: 99%

Precision, integrative medicine for pain management in sickle cell disease

Smith,

Valrie,

Jaja

et al. 2023

Front. Pain Res.

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Late effects of hemopoietic stem cell transplant for sickle cell disease: monitoring and management

Goldenberg,

Lanzkron,

Pecker

2024

Expert Review of Hematology

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What interval of daily pain assessment is required to reliably diagnose chronic pain in SCD? The Pain in Sickle Cell Epidemiology Study

Smith,

McClish,

Valrie

et al. 2024

Journal of Sickle Cell Disease

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Background Chronic pain in sickle cell disease has been defined as pain on most days over 6 months. In the landmark Pain in Sickle Cell Epidemiology Study, 60% of patients submitted < 5 of the expected 6 months of pain diaries. Identifying chronic SCD pain using this long daily assessment interval is impractical. We therefore examined whether shorter, less burdensome intervals could accurately identify chronic sickle cell disease pain. Method As the gold-standard sample, we chose the 116 Pain in Sickle Cell Epidemiology Study patients who submitted > 5 months of diaries (153) and >49% of diaries during all months from 1-4. Using the same dataset, we tested daily diary assessment over shorter intervals: 2 weeks, 1 month, 2 months, 3 months, and 4 months. We defined chronic pain as intensity rated as > 0 on > 50% of diary days, regardless of interval. We then calculated the sensitivity and specificity of each diary interval. Results Among the gold-standard sample, 51.3% of patients had diary-defined chronic pain. Collection intervals of two months or more yielded similar chronic pain prevalences with identically high sensitivity (98.3%) and specificity (93%). Intervals of one month and two weeks yielded increasingly lower specificity (80.7%, 73.7% respectively), but preserved sensitivity (≥96.6%). Conclusion In the Pain in Sickle Cell Epidemiology Study, intervals of two months or more of daily diary collection yielded high sensitivity and specificity, compared to an interval of 5-6 months. One may reasonably diagnose chronic sickle cell disease pain using two months of daily diaries.

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Multimodal phenotyping and correlates of pain following hematopoietic cell transplant in children with sickle cell disease

Cited by 3 publications

References 43 publications

Precision, integrative medicine for pain management in sickle cell disease

Precision, integrative medicine for pain management in sickle cell disease

Late effects of hemopoietic stem cell transplant for sickle cell disease: monitoring and management

What interval of daily pain assessment is required to reliably diagnose chronic pain in SCD? The Pain in Sickle Cell Epidemiology Study

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