Sickle cell pain: a critical reappraisal
Sickle cell pain: a critical reappraisal
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DOI：
10.1182/blood-2012-04-383430
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发表时间：
2012-11-01
期刊：
影响因子：
20.3
通讯作者：
Adams-Graves, Patricia
中科院分区：
文献类型：
--
作者：
Ballas, Samir K.;Gupta, Kalpna;Adams-Graves, Patricia
镰状细胞疼痛包括3种类型：急性复发性疼痛危象、慢性疼痛综合征和神经性疼痛。急性疼痛危象是该疾病的标志，也是急诊科住院和治疗的最常见原因。它经历了4个阶段：前驱期、初始期、建立期和解决期。每一次急性疼痛发作都与炎症有关，炎症伴随着反复发作，通常最终导致严重的并发症和器官损伤，如急性胸部综合征、多器官衰竭和猝死。在危机的前驱期，三种病理生理事件一致起作用：血管闭塞、炎症和伤害感受。在前驱期中止急性疼痛发作可能会预防或最大限度地减少组织损伤。我们的假设是，用水合作用、抗炎药、积极的镇痛和可能的血管扩张剂来处理这些事件可以中止危象，防止或尽量减少进一步的损害。慢性疼痛综合征与缺血性坏死和腿部溃疡相关或伴随。神经性疼痛在镰状细胞病患者中没有得到很好的研究，但已在转基因镰状小鼠中建模。镰状细胞性疼痛的治疗应基于其自身的病理生理机制，而不是从其他非镰状细胞性疼痛综合征中借鉴。（血。2012;120（18）：3647-3656）
Sickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute painful episode at the prodromal phase could potentially prevent or minimize tissue damage. Our hypothesis is that managing these events with hydration, anti-inflammatory drugs, aggressive analgesia, and possibly vasodilators could abort the crisis and prevent or minimize further damage. Chronic pain syndromes are associated with or accompany avascular necrosis and leg ulcers. Neuropathic pain is not well studied in patients with sickle cell disease but has been modeled in the transgenic sickle mouse. Management of sickle cell pain should be based on its own pathophysiologic mechanisms rather than borrowing guidelines from other nonsickle pain syndromes. (Blood. 2012;120(18):3647-3656)