Sensory and Thermal Quantitative Testing in Children With Sickle Cell Disease.
Sensory and Thermal Quantitative Testing in Children With Sickle Cell Disease.
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DOI：
10.1097/mph.0000000000000214
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
Sethna NF
中科院分区：
文献类型：
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作者：
Jacob E;Chan VW;Hodge C;Zeltzer L;Zurakowski D;Sethna NF
对于镰状细胞病 (SCD) 的疼痛处理知之甚少。我们检查了患有 SCD 的儿童的机械和热感觉模式。 10-17 岁儿童（n=48；平均 13.7 ± 2.0；22 名女性）参加了定量感觉测试 (QST) 程序，并完成了生活质量 (PedsQL) 和焦虑和抑郁量表 (RCADS)。 13 名儿童表现出异常疼痛处理的证据，表现为对热或冷感觉的敏感性降低（感觉减退），以及非疼痛刺激时出现的疼痛（异常性疼痛）。与 35 名 QST 正常的 SCD 儿童相比，QST 异常亚组中与冷感和温感相关的疼痛等级显着较高（分别为 p=0.01 和 p=<0.0001）。 SCD 儿童出现感觉减退和异常性疼痛可能代表周围和中枢神经系统的异常变化。临床医生需要意识到，镰状细胞痛不仅可能是继发于血管闭塞和缺氧的炎症或缺血性疼痛，还可能是继发于神经损伤或神经功能障碍的神经性疼痛。 SCD 中的神经病理性疼痛可能是神经组织血管闭塞后组织损伤的结果，无论是外周还是中枢。未来的研究需要确定 SCD 儿童是否存在神经性疼痛。
Very little is known about pain processing in sickle cell disease (SCD). We examined the mechanical and thermal sensory patterns in children with SCD. Children ages 10–17 years (n=48; mean 13.7 ± 2.0; 22 females) participated in quantitative sensory testing (QST) procedures and completed a quality of life (PedsQL) and anxiety and depression scale (RCADS). Thirteen children showed evidence of abnormal pain processing, indicated by decreased sensitivity to heat or cold sensations (hypoesthesia), and pain experienced with non-painful stimuli (allodynia). Pain ratings associated with cold and warm sensations were significantly higher in the subgroup with abnormal QST compared to the 35 SCD children with normal QST (p=0.01 and p= <0.0001, respectively). The presence of hypoesthesia and allodynia in children with SCD may represent abnormal changes in the peripheral and central nervous system. Clinicians need to be aware that sickle cell pain may not only be inflammatory or ischemic secondary to vaso-occlusion and hypoxia, but may also be neuropathic secondary to nerve injury or nerve dysfunction. Neuropathic pain in SCD may be the result of tissue damage after vaso-occlusion in neural tissues, whether peripherally or centrally. Future studies are needed to determine the presence of neuropathic pain in children with SCD.