Sickle Cell Disease and Pain: Is it all Vaso-occlusive Crises?

OBJECTIVES Acute pain is the main complication of sickle cell disease. Chronic and neuropathic pain may also be experienced but have not been formally described in Jamaican patients. A cross-sectional study was conducted to determine their prevalence and characteristics, and to determine the common pain locations and modalities of management. METHODS All well patients 14 years and older, not pregnant and without history of clinical stroke were consecutively recruited. Anthropometric measurements, haematology studies, an analgesia checklist and the ASCQ-Me questionnaire were completed. The painDETECT questionnaire was completed to describe neuropathic pain and pain patterns - from which chronic pain was defined. RESULTS There were 257 subjects with 55.6% females, mean age of 31.7±12 and 75% SS genotype. Almost all persons (92.6%) had an acute pain crisis in their lifetime and 72.4% in the last year. The mean severity at last attack was 6.8±3.1 on a scale of 0 to 10. The prevalence of chronic and neuropathic pain was 21.5% and 17.9% respectively. Being female, the presence of current leg ulcers and the use of strong opioid in the last four weeks produced higher odds of neuropathic pain, whereas older age, milder genotypes and daily analgesic use had the highest odds of chronic pain. Opioids were used by 40.1% in the previous four weeks, while non-pharmacological analgesia such as physiotherapy was less used but reported to be very effective. DISCUSSION Chronic and neuropathic pain should be assessed during routine care of sickle cell pain so that targeted therapies can be applied.