Sickle-Cell Pain: Advances in Epidemiology and Etiology
Sickle-Cell Pain: Advances in Epidemiology and Etiology
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DOI：
10.1182/asheducation-2010.1.409
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发表时间：
2010-12-01
期刊：
影响因子：
--
通讯作者：
Scherer, Marshall
中科院分区：
文献类型：
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作者：
Smith, Wally R.;Scherer, Marshall
新的流行病学研究结果将镰状细胞病（SCD）的疼痛重新定位为比以前认为的更常见的慢性表现，尽管急性疼痛仍然是该疾病的标志。SCD疼痛强度、疼痛部位的数量和SCD疼痛导致的住院频率可能随着年龄的增长而恶化。在成人甚至儿童中，SCD疼痛的数量和严重程度可能被大大低估，因为SCD疼痛的大部分“冰山”在家中被“淹没”，当在急诊室和医院提供急性SCD护理时，医疗保健提供者只能看到冰山一角。这种“冰山现象”的影响对临床医生、研究人员、雇主、政策制定者和公众都很重要。然而，急诊室和医院使用SCD疼痛仍然普遍。通常，使用复发早，可能是急性疼痛管理不善的象征。新的数据显示SCD疼痛对健康相关的生活质量、睡眠、心理和社会健康产生了多种影响。SCD疼痛的严重程度与潜在的镰状血管病变的严重程度的关系尚不清楚，但流行病学证据和患者描述表明疼痛机制的时间演变。起初，在生命的前二十年中，血管闭塞和局部病变可能会导致越来越严重的伤害性疼痛。然后，在第三个和随后的几十年中，中枢神经性疼痛也可能由于过去和持续的伤害性刺激而演变。新的发现证实了SCD疼痛的环境因素，包括季节性（较冷）温度，气压和风速。
New epidemiological findings recast pain in sickle-cell disease (SCD) as being more often a chronic manifestation than was previously thought, although acute pain is still the hallmark of the disease. SCD pain intensity, the number of painful locations, and the frequency of hospitalizations due to SCD pain may worsen with age. In adults and even in children, the quantity and severity of SCD pain may be vastly underestimated, because most of the "iceberg" of SCD pain is "submerged" at home, and only the tip of the iceberg is seen by health care providers when acute SCD care is rendered in emergency rooms and hospitals. Implications of this "iceberg phenomenon" are significant for clinicians, researchers, employers, policy makers, and the public. Nevertheless, both emergency room and hospital utilization for SCD pain remain prevalent. Often, utilization recurs early, perhaps emblematic of poor acute pain management. New data show the protean impacts of SCD pain on health-related quality of life, sleep, and psychological and social health. The relationship of the severity of SCD pain to the severity of underlying sickle vasculopathy is unclear, but epidemiologic evidence and patient descriptors suggest a temporal evolution of pain mechanisms. At first, increasingly worse nociceptive pain from vaso-occlusion and local lesions may evolve over the first two decades of life. Then, in the third and following decades, central neuropathic pain may also evolve due to past and continuing nociceptive stimuli. New findings confirm environmental contributors to SCD pain, including seasonal (colder) temperatures, barometric pressure, and wind speed.