Interventions for treating neuropathic pain in people with sickle cell disease

Evidence suggests neuropathic pain (NP) develops over time in sickle cell disease (SCD), contributing to a complex, difficult-to-treat phenotype, with management based on scant evidence. One characteristic of NP found is hyperalgesia caused by nervous system sensitization, but risk factors for this have not been identified within the SCD population, as exact mechanisms leading to its development are not well defined.The SPICE (Sickle cell Pain: Intervention with Capsaicin Exposure) trial was a pilot safety and feasibility trial of high-dose (8%) topical capsaicin for patients with SCD and recurrent/chronic pain with neuropathic features, aimed at exploring capsaicin's utility as a mechanistic probe and adjunctive pain treatment for this population. Ten participants identifying "target" sites of pain with NP-type qualities consented to treatment. The primary endpoint was safety/tolerability. The novel Localized Peripheral Hypersensitivity Relief score (LPHR) was developed to determine improvement in sensitivity attributable to TRPV1 neutralization. There were no severe treatment-related adverse events. Higher baseline pain sensitivity at a given body site was associated with self-reported history of more frequent localized vaso-occlusive pain episodes at that site. There was a statistically significant improvement in the mean LPHR, evidencing TRPV1's importance to the development of hypersensitivity and a potential therapeutic benefit of capsaicin for SCD.

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Targeting TRPV1 activity via high‐dose capsaicin in patients with sickle cell disease

Glaros

Callaghan

Smith

et al. 2022

eJHaem

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Prevalence of neuropathic pain in adolescents with sickle cell disease: A single‐center experience

Cregan

Puri

Kang

et al. 2022

Pediatric Blood & Cancer

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Background Neuropathic pain (NP) has been previously explored in adolescents with sickle cell disease (SCD). This study aims to describe the prevalence of NP in adolescents with SCD at a single institution and to explore associated risk factors. Procedure We used the painDETECT questionnaire, one of the few pain phenotyping questionnaires validated for adolescents. We also evaluated the relationships between painDETECT scores and frequency of acute care visits and admissions for pain in the previous 12 months, and age, respectively. Patients 12–18 years old were surveyed from June to July 2019. A retrospective approach was used to answer the remaining research questions. Results Eighty‐one and seven surveys were completed in the outpatient and inpatient settings, respectively. PainDETECT scores suggestive of NP were more prevalent in inpatient surveys than in outpatient surveys. The difference between the mean painDETECT scores of each group was significant when using a general linear mixed model. Most inpatients surveyed had ≥3 pain events in the previous 12 months. Further, older age and increased number of pain events in the previous 12 months were independently associated with higher painDETECT scores. Conclusions Overall, in our opinion, NP is not being evaluated for and treated sufficiently in pediatric SCD, especially in the setting of inpatient acute vaso‐occlusive crisis. Age and number of acute pain events/admissions in the previous 12 months can be used to identify patients likely to be at risk for NP. It is important to continue to identify NP and develop NP‐targeting treatment plans.

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Neurologic Findings in Patients With Sickle Cell Disease

Ali

2024

Neur Clin Pract

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Interventions for treating neuropathic pain in people with sickle cell disease

Cited by 4 publications

References 36 publications

Targeting TRPV1 activity via high‐dose capsaicin in patients with sickle cell disease

Targeting TRPV1 activity via high‐dose capsaicin in patients with sickle cell disease

Prevalence of neuropathic pain in adolescents with sickle cell disease: A single‐center experience

Neurologic Findings in Patients With Sickle Cell Disease

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