title: An Evaluation of Central Sensitization in Patients With Sickle Cell Disease.
abstract: Central sensitization (CS), nociceptive hyperexcitability known to amplify and maintain clinical pain, has been identified as a leading culprit responsible for maintaining pain in several chronic pain conditions. Recent evidence suggests that 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 who may have a heightened CS profile. The present study categorized patients with SCD on the basis of QST responses into a high or low CS phenotype and compared these groups according to measures of clinical pain, vaso-occlusive crises, psychosocial factors, and sleep continuity. Eighty-three adult patients with SCD completed QST, questionnaires, and daily sleep and pain diaries over a 3-month period, weekly phone calls for 3 months, and monthly phone calls for 12 months. Patients were divided into CS groups (ie, no/low CS [n = 17] vs high CS [n = 21]), on the basis of thermal and mechanical temporal summation and aftersensations, which were norm-referenced to 47 healthy control subjects. High CS subjects reported more clinical pain, vaso-occlusive crises, catastrophizing, and negative mood, and poorer sleep continuity (Ps < .05) over the 18-month follow-up period. Future analyses should investigate whether psychosocial disturbances and sleep mediate the relationship between CS and pain outcomes.
  
  
  
  In general, SCD patients with greater CS had more clinical pain, more crises, worse sleep, and more psychosocial disturbances compared with the low CS group.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ccampb41@jhmi.edu.
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Campbell
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, Maryland.
authors.forename: Gyasi
authors.initials: G
authors.lastname: Moscou-Jackson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: C Patrick
authors.initials: CP
authors.lastname: Carroll
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Kasey
authors.initials: K
authors.lastname: Kiley
authors.affiliation: Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Carlton
authors.initials: C
authors.lastname: Haywood
authors.affiliation: Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Lanzkron
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Matthew
authors.initials: M
authors.lastname: Hand
authors.affiliation: Departments of Anesthesiology, Perioperative, Pain Medicine, and Psychiatry, Harvard Medical School, and Brigham and Women's Hospital, Pain Management Center, Chestnut Hill, Massachusetts.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Haythornthwaite
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000755:Anemia, Sickle Cell / Q000503:physiopathology* / Q000523:psychology*; D058443:Catastrophization / Q000209:etiology*; D059333:Central Nervous System Sensitization / Q000502:physiology*; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology*; D010641:Phenotype; D010812:Physical Stimulation / Q000009:adverse effects; D012893:Sleep Wake Disorders / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: Sickle cell disease; catastrophizing; central sensitization; clinical pain; laboratory pain; quantitative sensory testing; sleep