Sickle cell disease chronic joint pain: Clinical assessment based on maladaptive central nervous system plasticity

Abstract

Chronic joint pain (CJP) is among the significant musculoskeletal comorbidities in sickle cell disease (SCD) individuals. However, many healthcare professionals have difficulties in understanding and evaluating it. In addition, most musculoskeletal evaluation procedures do not consider central nervous system (CNS) plasticity associated with CJP, which is frequently maladaptive. This review study highlights the potential mechanisms of CNS maladaptive plasticity related to CJP in SCD and proposes reliable instruments and methods for musculoskeletal assessment adapted to those patients. A review was carried out in the PubMed and SciELO databases, searching for information that could help in the understanding of the mechanisms of CNS maladaptive plasticity related to pain in SCD and that presented assessment instruments/methods that could be used in the clinical setting by healthcare professionals who manage chronic pain in SCD individuals. Some maladaptive CNS plasticity mechanisms seem important in CJP, including the impairment of pain endogenous control systems, central sensitization, motor cortex reorganization, motor control modification, and arthrogenic muscle inhibition. Understanding the link between maladaptive CNS plasticity and CJP mechanisms and its assessment through accurate instruments and methods may help healthcare professionals to increase the quality of treatment offered to SCD patients.

Impact of Tender Points, Average Pain, Catastrophizing, Central Sensitization, Anxiety, and Depression on Quality of Life in Individuals with Sickle Cell Disease.

“…Sixty percent of the sample declared widespread pain, an important characteristic of CS [31]. This highlights the importance of individuals with SCD needing speci c evaluation and management [13].…”

“…The participation of central sensitization (CS) in the perpetuation and increase of pain in individuals with SCD has been studied in several research centers providing su cient evidence of its contribution to the chronicity of pain [2,[10][11][12]. The assessment of central CS in SCD individuals in clinical settings context has been recommended [13]. Using reliable methods such as Quantitative Sensory Testing (QST), Conditioned pain modulation (CPM), and the Central Sensitization Inventory can help clinical professionals better understand the changes chronic pain brings to these individuals and how much it can impact their quality of life.…”