Sickle cell disease: a natural model of acute and chronic pain
Sickle cell disease: a natural model of acute and chronic pain
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DOI：
10.1097/j.pain.0000000000000824
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发表时间：
2017-04-01
期刊：
影响因子：
7.4
通讯作者：
Stucky, Cheryl L.
中科院分区：
文献类型：
--
作者：
Brandow, Amanda M.;Zappia, Katherine J.;Stucky, Cheryl L.
一名患有严重镰状细胞病 (SCD) 的 19 岁女性患者因剧烈疼痛就诊于血液科医生。 16 年前，她因急性疼痛治疗而住院 4 次，急诊科就诊 2 次。 16 至 19 年间，她住院 10 次，疼痛的频率和严重程度显着增加，并且她几乎每天都会感到疼痛。她的疼痛描述包括辐射、灼烧、刺痛、电击和麻木，她报告说皮肤疼痛，伴有轻微的皮肤压力和寒冷的温度。疼痛部位包括胸部、腰部、膝盖、脚部和“全身”。 18 岁时，她开始服用羟基脲，它能诱导胎儿血红蛋白的产生，并改善一些 SCD 并发症，包括急性疼痛。尽管血液学反应呈阳性，但严重疼痛持续存在，严重影响了她的生活质量。她的止痛方案包括几乎每天服用羟考酮、曲马多和布洛芬。这种常见病例提出的问题包括：引起疼痛的根本机制是什么？为什么她的疼痛从小时候的急性和间歇性疼痛转变为青少年时的慢性、几乎每天的疼痛？可以使用哪些替代疼痛治疗方法？长期阿片类药物治疗会造成哪些有害影响？
A 19-year-old female patient with severe sickle cell disease (SCD) presented to her hematologist with severe pain. Prior to 16 years, she reported 4 hospitalizations and 2 emergency department visits for acute pain management. Her pain significantly increased in frequency and severity between 16 and 19 years with 10 hospitalizations, and she reported almost daily pain. Her pain descriptors included radiating, burning, tingling, electric shocks, and numbness, and she reported cutaneous pain with slight skin pressure and with cold temperatures. Pain locations included chest, lower back, knees, feet, and “all over.” At 18 years, she started hydroxyurea, which induces the production of fetal hemoglobin and ameliorates some SCD complications, including acute pain. Despite a positive hematological response, significant pain persisted, severely impacting her quality of life. Her pain regimen included almost daily oxycodone, tramadol, and ibuprofen. Questions raised by this common case include the following: What is the underlying mechanism (s) causing the pain? Why did her pain transition from acute and intermittent as a young child to chronic, almost daily pain as an adolescent? What alternative pain treatments can be used? What deleterious effects does chronic opioid treatment cause?