Treating Chronic Pain in Sickle Cell Disease

Chronic pain in sickle cell disease (SCD) refers to pain being present most of the days and lasting over three months.

Although the pathophysiology of pain is not well described, we can safely conclude that nerve damage, chronic inflammation, and in some cases, opioid use can promote central sensitization of the pain that can lead to chronic pain in SCD patients.

In SCD , chronic pain could result from damage to the body caused by repeated sickling. Vaso-occlusive crises damage blood vessels and could lead to permanently restricting blood flow. Another cause of pain in SCD patients is neuropathic pain. Sometimes people with SCD develop persistent nerve pain as a result of damage in nerves that detect pain or changes in the way that brain processes signals of pain.

Allodynia is a condition that occurs when an individual experiences pain from stimuli that do not normally cause pain, whereas hyperalgesia occurs when an individual experiences an enhanced sensitivity to a known painful trigger. Finally, chronic exposure to high doses of opioids may contribute to chronic pain in SCD from either opioid-induced hyperalgesia and/or opioid withdrawal.

Regarding the approach of dealing with chronic pain in SCD, it is crucial to offer SCD patients emotional support, validation, cognitive strategies, and pharmacotherapy in their pain’s management plan.

Interventions involving cognitive behavioral techniques, training in mindfulness-based pain management, and multidisciplinary team approaches could reduce pain associated with their disease.

Authors of a recent study, published in the New England Journal of Medicine, describe the components of a biopsychosocial approach to pain management in SCD as per below:

• Mindfulness-based pain-management training to help people recognize pain triggers and modulate emotional and physical responses to pain.
• Educational strategies that empower adults with SCD to recognize and alter the personal and societal conditions that exacerbate pain.
• Options to incorporate psychological services on the basis of patient need, including cognitive and dialectical behavioral therapy, long-term psychotherapy, addiction counseling, and more intensive therapies, when warranted.
• A clinical pain-management approach based on acceptance and validation of the patient’s subjective experience of pain, with the primary goal of satisfactory pain relief rather than opioid rationing.
• Prompt and unimpeded access to acute pain management in outpatient infusion centers, emergency departments, and inpatient settings, when needed.
• Respectful, compassionate, and trauma-informed treatment throughout the health care system, with the recognition that SCD is among the most painful of all health conditions.