source: The Journal of Pain

year: 2015

authors: G. Moscou-Jackson, C. Campbell, P. Finan, C. Carroll, S. Lanzkron, C. Haywood Jr., J. Haythornthwaite

Central sensitization (CS) has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. It may explain differences in the symptom experience of individuals with Sickle Cell Disease (SCD). Quantitative sensory testing (QST) can be used to examine CS and identify individuals that may have a heightened CS profile. The present study identified and categorized SCD patients based on QST into a high or low CS phenotype and examined clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity (i.e. sleep duration, sleep fragmentation, and sleep efficiency) differences between groups.

Thirty-four (34) adults with SCD who completed daily morning (sleep) and evening (pain) diaries over a three-month period and underwent QST were included in these analyses. Participants were divided into CS groups (i.e. No/Low CS vs. High CS), based on thermal and mechanical temporal summation and after-sensations, which were norm-referenced to healthy, matched controls. Sixteen participants exhibited No or Low CS while 18 exhibited High CS. Participants in the High CS group were significantly older (mean age 43.5 years vs. 33.9 years, p = 0.02), but there was no significant difference in sex between groups.

During the average of 74 days of diary monitoring, participants in the High CS group on average experienced significantly higher clinical pain (mean difference = 24.0/100 points), more vaso-occlusive crises (mean difference = +15%), more catastrophizing, greater negative mood, and poorer sleep continuity (p’s <0.05), however, there was no difference in sleep duration between groups (p = 0.78).We demonstrated individual differences in central pain processing among individuals with SCD. In general, greater central sensitization was associated with higher clinical pain, more crises, worse sleep, and more psychosocial disturbances. Future analyses should investigate whether sleep and psychosocial disturbances mediate the relationship between central sensitization and pain outcomes.

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