title: Sensory and Thermal Quantitative Testing in Children With Sickle Cell Disease.
abstract: 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 to 17 years (n = 48; mean 13.7 ± 2.0 y; 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 nonpainful stimuli (allodynia). Pain ratings associated with cold and warm sensations were significantly higher in the subgroup with abnormal QST compared with 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 vasoocclusion 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.
authors.affiliation: *UCLA School of Nursing †Pediatric Pain and Comfort Care Program ‡Department of Pediatrics, Anesthesiology, Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA §Harvard Medical School, Boston Children's Hospital ∥Department of Anesthesia, Perioperative and Pain Medicine, Mayo Family Pediatric Pain Rehabilitation Center, Boston, MA.
authors.forename: Eufemia
authors.initials: E
authors.lastname: Jacob
authors.forename: Victoria Wong
authors.initials: VW
authors.lastname: Chan
authors.forename: Christopher
authors.initials: C
authors.lastname: Hodge
authors.forename: Lonnie
authors.initials: L
authors.lastname: Zeltzer
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Navil F
authors.initials: NF
authors.lastname: Sethna
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D003080:Cold Temperature; D005260:Female; D005500:Follow-Up Studies; D006358:Hot Temperature; D006801:Humans; D008297:Male; D010146:Pain / Q000209:etiology* / Q000473:pathology; D017288:Pain Threshold; D011379:Prognosis; D012678:Sensation Disorders / Q000209:etiology* / Q000473:pathology; D013314:Stress, Mechanical