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Sunwoo J, Shah P, Thuptimdang W, Khaleel M, Chalacheva P, Kato RM, Coates TD, Khoo MCK. Functional near-infrared spectroscopy-based prefrontal cortex oxygenation during working memory tasks in sickle cell disease. NEUROPHOTONICS 2023; 10:045004. [PMID: 37854507 PMCID: PMC10581024 DOI: 10.1117/1.nph.10.4.045004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/20/2023]
Abstract
Significance Sickle cell disease (SCD), characterized by painful vaso-occlusive crises, is associated with cognitive decline. However, objective quantification of cognitive decline in SCD remains a challenge, and the associated hemodynamics are unknown. Aim To address this, we utilized functional near-infrared spectroscopy (fNIRS) to measure prefrontal cortex (PFC) oxygenation responses to N -back working memory tasks in SCD patients and compared them with healthy controls. Approach We quantified the PFC oxygenation rate as an index of cognitive activity in each group and compared them. In half of the participants, a Stroop test was administered before they started N -back to elevate their baseline stress level. Results In SCD compared to healthy controls, we found that (1) under a high baseline stress level, there were significantly greater oxygenation responses during the 2-back task, further elevated with histories of stroke; (2) there was a marginally slower N -back response time, and it was even slower with a history of stroke; and (3) the task accuracy was not different. Conclusions Additional requirements for processing time, PFC resources, and PFC oxygenation in SCD patients offer an important basis for understanding their cognitive decline and highlight the potential of fNIRS for evaluating cognitive functions.
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Affiliation(s)
- John Sunwoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Massachusetts General Hospital, Harvard Medical School, Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, United States
| | - Payal Shah
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Wanwara Thuptimdang
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Prince of Songkla University, Faculty of Medicine, Institute of Biomedical Engineering, Department of Biomedical Sciences and Biomedical Engineering, Hat Yai, Songkhla, Thailand
| | - Maha Khaleel
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Patjanaporn Chalacheva
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
- Carnegie Mellon University, Department of Biomedical Engineering, Pittsburgh, Pennsylvania, United States
| | - Roberta M. Kato
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Division of Pediatric Pulmonology, Los Angeles, California, United States
| | - Thomas D. Coates
- Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Hematology Section of Children’s Center for Cancer, Blood Disease and Bone Marrow Transplantation, Los Angeles, California, United States
| | - Michael C. K. Khoo
- University of Southern California, Department of Biomedical Engineering, Los Angeles, California, United States
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2
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Thuptimdang W, Chalacheva P, Coates TD, Khoo MC. McDAPS: A multi-channel physiological signals display and analysis system for clinical researchers. SOFTWAREX 2023; 23:101482. [PMID: 38009083 PMCID: PMC10673622 DOI: 10.1016/j.softx.2023.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
We introduce McDAPS, an interactive software for assessing autonomic imbalance from non-invasive multi-channel physiological recordings. McDAPS provides a graphical user interface for data visualization, beat-to-beat processing and interactive analyses. The software extracts beat-to-beat RR interval systolic blood pressure, diastolic blood pressure, the pulse amplitude of photoplethysmogram and the pulse-to-pulse interval. The analysis modules include stationary and time-varying power spectral analyses, moving-correlation analysis and univariate analyses. Analyses can also be performed in batch mode if multiple datasets have to be processed in the same way. The program exports results in standard CSV format. McDAPS runs in MATLAB, and is supported on MS Windows and MAC OS systems. The MATLAB source code is available at https://github.com/thuptimd/McDAPS.git.
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Affiliation(s)
- Wanwara Thuptimdang
- Institute of Biomedical Engineering, Department of Biomedical Sciences and Biomedical Engineering, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Patjanaporn Chalacheva
- Biomedical Engineering Department, Carnegie Mellon University, Pittsburgh, PA, United States of America
| | - Thomas D. Coates
- Hematology Section, Cancer and Blood Disease Institute, Children’s Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States of America
| | - Michael C.K. Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, United States of America
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3
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López-Galán E, Vitón-Castillo AA, Carrazana-Escalona R, Planas-Rodriguez M, Fernández-García AA, Cutiño-Clavel I, Pascau-Simon A, Connes P, Sánchez-Hechavarría ME, Muñoz-Bustos GA. Autonomic and Vascular Responses during Reactive Hyperemia in Healthy Individuals and Patients with Sickle Cell Anemia. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1141. [PMID: 37374344 DOI: 10.3390/medicina59061141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/07/2023] [Accepted: 05/10/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: To compare autonomic and vascular responses during reactive hyperemia (RH) between healthy individuals and patients with sickle cell anemia (SCA). Materials and Methods: Eighteen healthy subjects and 24 SCA patients were subjected to arterial occlusion for 3 min at the lower right limb level. The pulse rate variability (PRV) and pulse wave amplitude were measured through photoplethysmography using the Angiodin® PD 3000 device, which was placed on the first finger of the lower right limb 2 min before (Basal) and 2 min after the occlusion. Pulse peak intervals were analyzed using time-frequency (wavelet transform) methods for high-frequency (HF: 0.15-0.4) and low-frequency (LF: 0.04-0.15) bands, and the LF/HF ratio was calculated. Results: The pulse wave amplitude was higher in healthy subjects compared to SCA patients, at both baseline and post-occlusion (p < 0.05). Time-frequency analysis showed that the LF/HF peak in response to the post-occlusion RH test was reached earlier in healthy subjects compared to SCA patients. Conclusions: Vasodilatory function, as measured by PPG, was lower in SCA patients compared to healthy subjects. Moreover, a cardiovascular autonomic imbalance was present in SCA patients with high sympathetic and low parasympathetic activity in the basal state and a poor response of the sympathetic nervous system to RH. Early cardiovascular sympathetic activation (10 s) and vasodilatory function in response to RH were impaired in SCA patients.
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Affiliation(s)
- Erislandis López-Galán
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Adrián Alejandro Vitón-Castillo
- Facultad de Ciencias Médicas "Dr. Ernesto Che Guevara de la Serna", Universidad de Ciencias Médicas de Pinar del Rio, Pinar del Rio 20100, Cuba
| | - Ramón Carrazana-Escalona
- Departamento de Ciencias Clínicas Básicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
| | - Maylet Planas-Rodriguez
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | | | - Ileana Cutiño-Clavel
- Departamento de Ciencias Básicas Biomédicas, Facultad de Medicina, Universidad de Ciencias Médicas de Santiago de Cuba, Santiago de Cuba 90100, Cuba
| | - Alexander Pascau-Simon
- Hospital General "Dr. Juan Bruno Zayas Alfonso", Laboratorio Vascular no Invasivo, Santiago de Cuba 90400, Cuba
| | - Philippe Connes
- LIBM Laboratory, Team "Vascular Biology and Red Blood Cell", Claude Bernard University Lyon 1, 69622 Lyon, France
| | - Miguel Enrique Sánchez-Hechavarría
- Grupo Bio-Bio Complejidad, Departamento de Ciencias Clínicas y Preclínicas, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
- Núcleo Científico de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Adventista de Chile, Chillán 3780000, Chile
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Zavanelli N, Lee SH, Guess M, Yeo WH. Soft wireless sternal patch to detect systemic vasoconstriction using photoplethysmography. iScience 2023; 26:106184. [PMID: 36879814 PMCID: PMC9985026 DOI: 10.1016/j.isci.2023.106184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/16/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Vasoconstriction is a crucial physiological process that serves as the body's primary blood pressure regulation mechanism and a key marker of numerous harmful health conditions. The ability to detect vasoconstriction in real time would be crucial for detecting blood pressure, identifying sympathetic arousals, characterizing patient wellbeing, detecting sickle cell anemia attacks early, and identifying complications caused by hypertension medications. However, vasoconstriction manifests weakly in traditional photoplethysmogram (PPG) measurement locations, like the finger, toe, and ear. Here, we report a wireless, fully integrated, soft sternal patch to capture PPG signals from the sternum, an anatomical region that exhibits a robust vasoconstrictive response. With healthy controls, the device is highly capable of detecting vasoconstriction induced endogenously and exogenously. Furthermore, in overnight trials with patients with sleep apnea, the device shows a high agreement (r2 = 0.74) in vasoconstriction detection with a commercial system, demonstrating its potential use in portable, continuous, long-term vasoconstriction monitoring.
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Affiliation(s)
- Nathan Zavanelli
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30024, USA.,IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Sung Hoon Lee
- IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA.,School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Matthew Guess
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30024, USA.,IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Woon-Hong Yeo
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30024, USA.,IEN Center for Human-Centric Interfaces and Engineering at the Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA 30332, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech and Emory University School of Medicine, Atlanta, GA 30332, USA.,Parker H. Petit Institute for Bioengineering and Biosciences, Neural Engineering Center, Institute for Materials, Institute for Robotics and Intelligent Machines, Georgia Institute of Technology, Atlanta, GA 30332, USA
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5
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Powell-Roach KL, Yao Y, Cao X, Chamala S, Wallace MR, Cruz-Almeida Y, Molokie RE, Wang ZJ, Wilkie DJ. Analysis of AVPR1A, thermal and pressure pain thresholds, and stress in sickle cell disease. FRONTIERS IN PAIN RESEARCH 2023; 3:1060245. [PMID: 36688082 PMCID: PMC9845903 DOI: 10.3389/fpain.2022.1060245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023] Open
Abstract
Aim In patients with sickle cell disease (SCD), negative physical and emotional experiences result from intense chronic and acute pain episodes, but factors underlying these, and their interactions, are not well understood. The arginine vasopressin receptor 1a gene (AVPR1A) single nucleotide polymorphism rs10877969 has been previously associated with aspects of acute pain and stress related pain. In this study, we tested for associations between this SNP, thermal and pressure pain thresholds, clinical pain, and stress in people with SCD. Methods 150 adults enrolled with SCD completed pain intensity measures (Average Pain Intensity, API) and the Perceived Stress Questionnaire (PSQ). Thermal and pressure pain threshold data were available from quantitative sensory testing (QST), and rs10877969 genotypes were obtained. Results In models adjusted for age and gender, between rs10877969 genotypes, we observed no significant differences in thermal (cold, p = 0.66; heat, p = 0.91) and mechanical (pressure, p = 0.33) pain thresholds. The association of rs10877969 with API (p = 0.09) was borderline, but non-significant with PSQ (p = 0.51). The correlation between clinical pain and environmental stress was significant, r = 0.18, p = 0.024, however, the interaction of genotype and PSQ was not significant (p = 0.63). Conclusion Clinical and experimental pain were not significantly associated with the rs10877969 genotype. The rs10877969 genotype did not moderate the correlation between environmental stress and clinical pain in this population. However, a trend toward a protective T allele effect on average pain rating in SCD warrants future exploration of this SNP/gene in SCD.
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Affiliation(s)
- Keesha L. Powell-Roach
- Department of Community and Population Health, University of Tennessee Health Science Center, College of Nursing, Memphis, TN, United States
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Xueyuan Cao
- Department of Community and Population Health, University of Tennessee Health Science Center, College of Nursing, Memphis, TN, United States
| | - Srikar Chamala
- Department of Pathology and Laboratory Medicine, Childrens Hospital of Los Angeles, Los Angeles, CA, United States
| | - Margaret R. Wallace
- Department of Molecular Genetics and Microbiology, University of Florida, College of Medicine, Gainesville, FL, United States
- University of Florida Genetics Institute, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- College of Dentistry, University of Florida, Gainesville, FL, United States
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL, United States
| | - Robert E. Molokie
- Department of Medicine, University of Illinois at Chicago, College of Medicine, Chicago, IL, United States
- Department of Pharmaceutical Sciences, Neurology and Bioengineering, University of Illinois College of Pharmacy, Chicago, IL, United States
- Medical Service, Jesse Brown VA Medical Center, Chicago, IL, United States
| | - Zaijie Jim Wang
- Department of Pharmaceutical Sciences, Neurology and Bioengineering, University of Illinois College of Pharmacy, Chicago, IL, United States
| | - Diana J. Wilkie
- Department of Biobehavioral Nursing Science, University of Florida, College of Nursing, Gainesville, FL, United States
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6
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Sexual violence as a precipitator of chronic pain in young adults with sickle cell disease. Blood Adv 2022; 6:4831-4833. [PMID: 35816686 PMCID: PMC9631675 DOI: 10.1182/bloodadvances.2022007600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
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7
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Thuptimdang W, Shah P, Khaleel M, Sunwoo J, Veluswamy S, Kato RM, Coates TD, Khoo MCK. Vasoconstriction Response to Mental Stress in Sickle Cell Disease: The Role of the Cardiac and Vascular Baroreflexes. Front Physiol 2021; 12:698209. [PMID: 34803725 PMCID: PMC8599360 DOI: 10.3389/fphys.2021.698209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
Recent studies have shown that individuals with sickle cell disease (SCD) exhibit greater vasoconstriction responses to physical autonomic stressors, such as heat pain and cold pain than normal individuals, but this is not the case for mental stress (MTS). We sought to determine whether this anomalous finding for MTS is related to inter-group differences in baseline cardiac and vascular autonomic function. Fifteen subjects with SCD and 15 healthy volunteers participated in three MTS tasks: N-back, Stroop, and pain anticipation (PA). R-R interval (RRI), arterial blood pressure and finger photoplethysmogram (PPG) were continuously monitored before and during these MTS tasks. The magnitude of vasoconstriction was quantified using change in PPG amplitude (PPGa) from the baseline period. To represent basal autonomic function, we assessed both cardiac and vascular arms of the baroreflex during the baseline period. Cardiac baroreflex sensitivity (BRSc) was estimated by applying both the "sequence" and "spectral" techniques to beat-to-beat measurements of systolic blood pressure and RRIs. The vascular baroreflex sensitivity (BRSv) was quantified using the same approaches, modified for application to beat-to-beat diastolic blood pressure and PPGa measurements. Baseline BRSc was not different between SCD and non-SCD subjects, was not correlated with BRSv, and was not associated with the vasoconstriction responses to MTS tasks. BRSv in both groups was correlated with mean PPGa, and since both baseline PPGa and BRSv were lower in SCD, these results suggested that the SCD subjects were in a basal state of higher sympathetically mediated vascular tone. In both groups, baseline BRSv was positively correlated with the vasoconstriction responses to N-back, Stroop, and PA. After adjusting for differences in BRSv within and between groups, we found no difference in the vasoconstriction responses to all three mental tasks between SCD and non-SCD subjects. The implications of these findings are significant in subjects with SCD since vasoconstriction reduces microvascular flow and prolongs capillary transit time, increasing the likelihood for vaso-occlusive crisis (VOC) to be triggered by exposure to stressful events.
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Affiliation(s)
- Wanwara Thuptimdang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Payal Shah
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Maha Khaleel
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - John Sunwoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Saranya Veluswamy
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Roberta M Kato
- Division of Pulmonology, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Thomas D Coates
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
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8
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Li F, Jackson T. Psychophysiological correlates of pain resilience in anticipating, experiencing, and recovering from pain. Psychophysiology 2021; 59:e13962. [PMID: 34716607 DOI: 10.1111/psyp.13962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022]
Abstract
Although researchers have documented behavioral and brain structure correlates of pain resilience, associated physiological responses have received little consideration. In this study, we assessed psychophysiological differences between high (HPR), moderate (MPR), and low (LPR) pain resilience subgroups during anticipation, experiencing, and recovery from laboratory pain. In an initial pain anticipation task, participants (79 women, 32 man) viewed visual cues to signal possible mild or intense shocks prior to receiving these shocks. Subsequently, in a pain recovery task, participants received uncued mild and intense shocks. Subjective appraisals were assessed during each task in tandem with continuous recording of skin conductance level (SCL), heart rate variability (HRV), and corrugator electromyography (cEMG). On physiological indexes, HPR subgroup members displayed significantly lower SCL than MPR and LPR subgroups did during anticipation and experiencing of pain while no resilience group effects were found for HRV or cEMG. During pain recovery, HPR and LPR subgroups displayed weaker SCL than the MPR subgroup did in the immediate aftermath of shock. However, HPR members continued to display lower SCL than other groups did over an extended recovery period. On self-report measures, the LPR subgroup reported higher levels of anticipatory anxiety and expected pain than HPR and MPR subgroups did during the pain anticipation task. Together, results suggested higher pain resilience is characterized, in part, by comparatively reduced SCL during the course of anticipating, experiencing and recovering from painful shock.
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Affiliation(s)
- Fenghua Li
- Key Laboratory of Cognition & Personality, Southwest University, Chongqing, China
| | - Todd Jackson
- Key Laboratory of Cognition & Personality, Southwest University, Chongqing, China.,Department of Psychology, University of Macau, Taipa, Macau S.A.R., China
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9
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Sagi V, Mittal A, Tran H, Gupta K. Pain in sickle cell disease: current and potential translational therapies. Transl Res 2021; 234:141-158. [PMID: 33711512 PMCID: PMC8217144 DOI: 10.1016/j.trsl.2021.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/26/2022]
Abstract
Pain is a major comorbidity of sickle cell disease (SCD). Patients with SCD may suffer from both acute and chronic pain. Acute pain is caused by recurrent and unpredictable episodes of vaso-occlusive crises (VOC), whereas the exact etiology of chronic pain is still unknown. Opioids are the mainstay for pain treatment, but the opioid epidemic has significantly altered access to prescription opioids and has brought concerns over their long-term use into the forefront, which have negatively impacted the treatment of sickle pain. Opioids remain potent analgesics but growing opioid-phobia has led to the realization of an unmet need to develop nonopioid therapies that can provide relief for severe sickle pain. This realization has contributed to the approval of 3 different drugs by the Food and Drug Administration (FDA) for the treatment of SCD, particularly to reduce VOC and/or have an impact on the pathobiology of SCD. In this review, we outline the challenges and need for validation of side-effects of opioids and provide an update on the development of mechanism-based translational therapies, specifically targeting pain in SCD.
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Affiliation(s)
- Varun Sagi
- School of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Aditya Mittal
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Huy Tran
- School of Medicine, Kansas City University, Joplin, Missouri
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine and Southern California Institute for Research and Education, VA Medical Center, Long Beach, California.
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10
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Linear heart rate variability measures in Sickle cell disease compared to the healthy control subjects: A systematic review and mete-analysis study. PHYSIOLOGY AND PHARMACOLOGY 2021. [DOI: 10.52547/phypha.26.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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11
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Chalacheva P, Ji Y, Rosen CL, DeBaun MR, Khoo MCK, Coates TD. Nocturnal peripheral vasoconstriction predicts the frequency of severe acute pain episodes in children with sickle cell disease. Am J Hematol 2021; 96:60-68. [PMID: 33027545 DOI: 10.1002/ajh.26014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 01/27/2023]
Abstract
The basic model of SCD physiology states that vaso-occlusion occurs when hemoglobin S-containing red blood cells (RBC) undergo sickling before they escape the capillary into a larger vessel. We have shown that mental stress, pain and cold, and events reported by patients to trigger SCD vaso-occlusive crisis (VOC), cause rapid and significant decrease in blood flow, reducing the likelihood that RBC could transit the microvasculature before sickling occurs. However, the critical link between decrease in microvascular blood flow and the incidence of future sickle VOC has never been established experimentally in humans. Using data from centrally adjudicated, overnight polysomnograms (PSG), previously collected in a prospective multi-center cohort sleep study, we analyzed the beat-to-beat amplitudes of vasoconstriction reported by the fingertip photoplethysmogram in 212 children and adolescents with SCD and developed an algorithm that detects vasoconstriction events and quantifies the magnitude (Mvasoc ), duration, and frequency of vasoconstriction that reflect the individual's inherent peripheral vasoreactivity. The propensity to vasoconstrict, quantified by median Mvasoc , predicted the incidence rate of post-PSG severe acute vaso-occlusive pain events (P = .006) after accounting for age and hemoglobin. Indices of sleep-disordered breathing contributed to median Mvasoc but did not predict future pain rate. Median Mvasoc was not associated with vaso-occlusive pain events that occurred prior to each PSG. These results show that SCD individuals with high inherent propensity to vasoconstrict have more frequent severe acute pain events. Our empirical findings are consistent with the fundamental SCD hypothesis that decreased microvascular flow promotes microvascular occlusion.
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Affiliation(s)
| | - Yunhua Ji
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Carol L. Rosen
- Department of Pediatrics, Division of Pediatric Pulmonary Allergy/Immunology and Sleep, University Hospitals‐Cleveland Medical Center, Rainbow Babies and Children's Hospitals Cleveland Ohio
| | - Michael R. DeBaun
- Division of Hematology‐Oncology, Department of Pediatrics Vanderbilt University School of Medicine Nashville Tennessee
| | - Michael C. K. Khoo
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Thomas D. Coates
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Department of Pediatrics University of Southern California Keck School of Medicine Los Angeles California
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12
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Marusak HA, Iadipaolo AS, Cohen C, Goldberg E, Taub JW, Harper FWK, Bluth MH, Rabinak CA. Martial Arts-Based Therapy Reduces Pain and Distress Among Children with Chronic Health Conditions and Their Siblings. J Pain Res 2020; 13:3467-3478. [PMID: 33402843 PMCID: PMC7778380 DOI: 10.2147/jpr.s283364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/18/2020] [Indexed: 01/14/2023] Open
Abstract
Objective Test whether a martial arts-based therapy, Kids Kicking Cancer (KKC), can reduce pain and emotional distress in children with cancer, other chronic health conditions (e.g., sickle cell), and healthy siblings. Methods This study surveyed children’s pain and distress levels immediately before and after a 1-hr in-person KKC class. Eligible participants were enrolled in standard KKC classes, were diagnosed with a chronic health condition (e.g., cancer, sickle cell) or were the sibling of a child diagnosed and were between the ages of 5–17 years (inclusive). Children reported on their pain and distress using Likert-style scales (Coloured Analog Scale and modified FACES scale, respectively). Friedman test was used to test for overall changes in pain and distress, and within subgroups. Age and sex effects were evaluated using Spearman’s rank-order correlation. Additional Yes/No questions were administered regarding KKC satisfaction and use of techniques. Results Fifty-nine youth (19 cancer patients, 17 non-cancer patients, 23 siblings; 5–17 yrs, 26 females) completed this study. Overall, there was a significant reduction in pain (p = 0.033) and emotional distress (p < 0.001) after a 1-hr class, with 50% and 89% of youth reporting a reduction in pain and distress, respectively. On average, pain levels remained within the mild/moderate range on average (i.e., pre vs. post levels; pre: M = 1.67, post: M = 1.33) and emotional distress went from mild/moderate to none/mild distress, on average (pre: M = 1.92, post: M = 1.08). Youth with higher pre-class pain and distress reported greater reductions (p = 0.001 and p < 0.001, respectively). The reduction in pain appeared to be most pronounced with cancer and non-cancer patients. In contrast, the reduction in distress appeared to be most pronounced among healthy siblings. However, overall, reductions in pain and distress did not significantly differ among subgroups (i.e., cancer patients, non-cancer patients, siblings), and change in pain and distress was not associated with age or sex. Ninety-six percent of youth would recommend KKC to others and 81% reported using KKC techniques (e.g., the Breath BrakeTM or other martial arts techniques) outside of class, such as at home. Conclusion Results support the more widespread application of KKC as a psychosocial intervention for reducing pain and distress in various pediatric populations.
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Affiliation(s)
- Hilary A Marusak
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.,Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA.,Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA
| | - Allesandra S Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Elimelech Goldberg
- Kids Kicking Cancer, Southfield, MI, USA.,Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Jeffrey W Taub
- Department of Pediatrics, School of Medicine, Wayne State University, Detroit, MI, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Felicity W K Harper
- Population Studies and Disparities Research Program, Karmanos Cancer Institute, Detroit, MI, USA.,Department of Oncology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Martin H Bluth
- Kids Kicking Cancer, Southfield, MI, USA.,Department of Pathology, School of Medicine, Wayne State University, Detroit, MI, USA
| | - Christine A Rabinak
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, USA.,Merrill Palmer Skillman Institute, Wayne State University, Detroit, MI, USA.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.,Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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13
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Kiven S, Wang Y, Aich A, Argueta DA, Lei J, Sagi V, Tennakoon M, Bedros SJ, Lambrecht N, Gupta K. Spatiotemporal Alterations in Gait in Humanized Transgenic Sickle Mice. Front Immunol 2020; 11:561947. [PMID: 33178189 PMCID: PMC7593487 DOI: 10.3389/fimmu.2020.561947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/07/2020] [Indexed: 12/15/2022] Open
Abstract
Sickle cell disease (SCD) is a hemoglobinopathy affecting multiple organs and featuring acute and chronic pain. Purkinje cell damage and hyperalgesia have been demonstrated in transgenic sickle mice. Purkinje cells are associated with movement and neural function which may influence pain. We hypothesized that Purkinje cell damage and/or chronic pain burden provoke compensatory gait changes in sickle mice. We found that Purkinje cells undergoe increased apoptosis as shown by caspase-3 activation. Using an automated gait measurement system, MouseWalker, we characterized spatiotemporal gait characteristics of humanized transgenic BERK sickle mice in comparison to control mice. Sickle mice showed alteration in stance instability and dynamic gait parameters (walking speed, stance duration, swing duration and specific swing indices). Differences in stance instability may reflect motor dysfunction due to damaged Purkinje cells. Alterations in diagonal and all stance indices indicative of hesitation during walking may originate from motor dysfunction and/or arise from fear and/or anticipation of movement-evoked pain. We also demonstrate that stance duration, diagonal swing indices and all stance indices correlate with both mechanical and deep tissue hyperalgesia, while stance instability correlates with only deep tissue hyperalgesia. Therefore, objective analysis of gait in SCD may provide insights into neurological impairment and pain states.
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Affiliation(s)
- Stacy Kiven
- Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, United States.,Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, United States
| | - Ying Wang
- Department of Anesthesia, Stark Neuroscience Research Institute, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anupam Aich
- Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Donovan A Argueta
- Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Jianxun Lei
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, United States
| | - Varun Sagi
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, United States
| | - Madhushan Tennakoon
- Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, United States
| | - Saad J Bedros
- College of Science & Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Nils Lambrecht
- Pathology and Laboratory Medicine, Long Beach VA Healthcare System, Long Beach, CA, United States
| | - Kalpna Gupta
- Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, CA, United States.,Division of Hematology, Oncology and Transplantation, Department of Medicine, Vascular Biology Center, University of Minnesota, Minneapolis, MN, United States.,Southern California Institute for Research and Education, Long Beach VA Healthcare System, Long Beach, CA, United States
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14
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Veluswamy S, Shah P, Khaleel M, Thuptimdang W, Chalacheva P, Sunwoo J, Denton CC, Kato R, Detterich J, Wood JC, Sposto R, Khoo MCK, Zeltzer L, Coates TD. Progressive vasoconstriction with sequential thermal stimulation indicates vascular dysautonomia in sickle cell disease. Blood 2020; 136:1191-1200. [PMID: 32518948 PMCID: PMC7472716 DOI: 10.1182/blood.2020005045] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/11/2020] [Indexed: 12/18/2022] Open
Abstract
Persons with sickle cell disease (SCD) exhibit subjective hypersensitivity to cold and heat perception in experimental settings, and triggers such as cold exposure are known to precipitate vaso-occlusive crises by still unclear mechanisms. Decreased microvascular blood flow (MBF) increases the likelihood of vaso-occlusion by increasing entrapment of sickled red blood cells in the microvasculature. Because those with SCD have dysautonomia, we anticipated that thermal exposure would induce autonomic hypersensitivity of their microvasculature with an increased propensity toward vasoconstriction. We exposed 17 patients with SCD and 16 control participants to a sequence of predetermined threshold temperatures for cold and heat detection and cold and heat pain via a thermode placed on the right hand. MBF was measured on the contralateral hand by photoplethysmography, and cardiac autonomic balance was assessed by determining heart rate variability. Thermal stimuli at both detection and pain thresholds caused a significant decrease in MBF in the contralateral hand within seconds of stimulus application, with patients with SCD showing significantly stronger vasoconstriction (P = .019). Furthermore, patients with SCD showed a greater progressive decrease in blood flow than did the controls, with poor recovery between episodes of thermal stimulation (P = .042). They had faster vasoconstriction than the controls (P = .033), especially with cold detection stimulus. Individuals with higher anxiety also experienced more rapid vasoconstriction (P = .007). Augmented vasoconstriction responses and progressive decreases in perfusion with repeated thermal stimulation in SCD are indicative of autonomic hypersensitivity in the microvasculature. These effects are likely to increase red cell entrapment in response to clinical triggers such as cold or stress, which have been associated with vaso-occlusive crises in SCD.
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Affiliation(s)
- Saranya Veluswamy
- Division of Hematology/Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Payal Shah
- Division of Hematology/Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Maha Khaleel
- Division of Hematology/Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | - Wanwara Thuptimdang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - John Sunwoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Christopher C Denton
- Division of Hematology/Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
| | | | | | | | - Richard Sposto
- Division of Preventive Medicine, Children's Hospital Los Angeles, Los Angeles, CA; and
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA
| | - Lonnie Zeltzer
- Pediatric Pain Program, University of California, Los Angeles, CA
| | - Thomas D Coates
- Division of Hematology/Oncology, Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Los Angeles, CA
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15
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Darbari DS, Sheehan VA, Ballas SK. The vaso-occlusive pain crisis in sickle cell disease: Definition, pathophysiology, and management. Eur J Haematol 2020; 105:237-246. [PMID: 32301178 DOI: 10.1111/ejh.13430] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/09/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Abstract
Early diagnosis, treatment, and prevention of a vaso-occlusive crisis (VOC) are critical to the management of patients with sickle cell disease. It is essential to differentiate between VOC-associated pain and chronic pain, hyperalgesia, neuropathy, and neuropathic pain. The pathophysiology of VOCs includes polymerization of abnormal sickle hemoglobin, inflammation, and adhesion. Hydroxyurea, L-glutamine, crizanlizumab, and voxelotor have been approved by the US Food and Drug Administration for reducing the frequency of VOCs; the European Medicines Agency has approved only hydroxyurea. Other novel treatments are in late-stage clinical development in both the United States and the European Union. The development of agents for prevention and treatment of VOCs should be driven by our understanding of its pathophysiology.
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Affiliation(s)
- Deepika S Darbari
- Division of Hematology, Children's National Medical Center, Washington, DC, USA
| | - Vivien A Sheehan
- Department of Pediatrics, Division of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Samir K Ballas
- Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, PA, USA
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16
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Espinoza J, Shah P, Veluswamy S, Zeltzer L, Khoo MC, Coates TD, Baskin J. Aura and mental stress are associated with reports of pain in sickle cell disease-a pilot study using a mobile application. Am J Hematol 2020; 95:E101-E103. [PMID: 31957078 DOI: 10.1002/ajh.25736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Juan Espinoza
- Division of General Pediatrics, Childrenʼs Hospital Los Angeles, Keck School of Medicine University of Southern California Los Angeles California
| | - Payal Shah
- Division of Hematology, Childrenʼs Center for Cancer and Blood Diseases, Childrenʼs Hospital Los Angeles, Keck School of Medicine University of Southern California Los Angeles California
| | - Saranya Veluswamy
- Division of Hematology, Childrenʼs Center for Cancer and Blood Diseases, Childrenʼs Hospital Los Angeles, Keck School of Medicine University of Southern California Los Angeles California
| | - Lonnie Zeltzer
- Pediatric Pain Research Program, David Geffen School of Medicine at UCLA University of California Los Angeles California
| | - Michael C.K. Khoo
- Department of Biomedical Engineering University of Southern California Los Angeles California
| | - Thomas D. Coates
- Division of Hematology, Childrenʼs Center for Cancer and Blood Diseases, Childrenʼs Hospital Los Angeles, Keck School of Medicine University of Southern California Los Angeles California
| | - Jacquelyn Baskin
- Division of Hematology & Oncology University of North Carolina at Chapel Hill Chapel Hill North Carolina
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17
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Fiocchi J, Urits I, Orhurhu V, Orhurhu MS, Giacomazzi S, Hoyt B, Kaye AD, Kaye RJ, Viswanath O. A Comprehensive Review of the Treatment and Management of Pain in Sickle Cell Disease. Curr Pain Headache Rep 2020; 24:17. [PMID: 32200490 DOI: 10.1007/s11916-020-00854-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Sickle cell disease (SCD) is a hematological disorder which leads to serious complications in multiple organ systems. While significant research has addressed many of the effects of acute pain episodes and end-organ damage connected to this disease, little has approached the chronic pain state associated with this condition. RECENT FINDINGS Associated chronic pain represents a significant detractor from the quality of life experienced by these patients, affecting over half of those with SCD on more days than not. Current treatment typically is centered upon preventing and responding to acute vasoocclusive crises, presumably because this is the most common reason for hospitalization in these patients. The lack of management of chronic pain symptoms leaves many with SCD in a state of suffering. In this review, the treatment methodologies of SCD patients are examined including alternative treatments, both pharmaceutical and non-pharmaceutical, as well as procedural approaches specifically aimed at reducing chronic pain in these patients.
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Affiliation(s)
- Jacob Fiocchi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Briggs Hoyt
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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18
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Autonomically-mediated decrease in microvascular blood flow due to mental stress and pain in sickle cell disease: A target for neuromodulatory interventions. Complement Ther Med 2020; 49:102334. [PMID: 32147052 DOI: 10.1016/j.ctim.2020.102334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
Abstract
Pain and vaso-occlusive crises (VOC) are hallmark complications of sickle cell disease (SCD) and result in significant physical and psychosocial impairment. The variability in SCD pain frequency and triggers for the transition from steady state to VOC are not well understood. This paper summarizes the harmful physiological effects of pain and emotional stressors on autonomically-mediated vascular function in individuals with SCD and the effects of a cognitive, neuromodulatory intervention (i.e. hypnosis) on microvascular blood flow. We reviewed recent studies from the authors' vascular physiology laboratory that assessed microvascular responses to laboratory stressors in individuals with SCD. Results indicate that participants with SCD exhibit marked neurally mediated vascular reactivity in response to pain, pain-related fear, and mental stress. Further, pilot study results show that engagement in hypnosis may attenuate harmful microvascular responses to pain. The collective results demonstrate that autonomically-mediated vascular responses to pain and mental stress represent an important SCD intervention target. This ongoing work provides physiological justification for the inclusion of cognitive, neuromodulatory and complementary treatments in SCD disease management and may inform the development of targeted, integrative interventions that prevent the enhancement of autonomic vascular dysfunction in SCD.
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19
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Farrell AT, Panepinto J, Carroll CP, Darbari DS, Desai AA, King AA, Adams RJ, Barber TD, Brandow AM, DeBaun MR, Donahue MJ, Gupta K, Hankins JS, Kameka M, Kirkham FJ, Luksenburg H, Miller S, Oneal PA, Rees DC, Setse R, Sheehan VA, Strouse J, Stucky CL, Werner EM, Wood JC, Zempsky WT. End points for sickle cell disease clinical trials: patient-reported outcomes, pain, and the brain. Blood Adv 2019; 3:3982-4001. [PMID: 31809538 PMCID: PMC6963237 DOI: 10.1182/bloodadvances.2019000882] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/26/2019] [Indexed: 12/12/2022] Open
Abstract
To address the global burden of sickle cell disease (SCD) and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to: patient-reported outcomes (PROs), pain (non-PROs), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the PROs, pain, and brain panels, as well as relevant findings and recommendations from the biomarkers panel. The panels identify end points, where there were supporting data, to use in clinical trials of SCD. In addition, the panels discuss where further research is needed to support the development and validation of additional clinical trial end points.
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Affiliation(s)
| | - Julie Panepinto
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Ankit A Desai
- Krannert Institute of Cardiology, Indiana University, Bloomington, IN
| | - Allison A King
- Division of Hematology and Oncology in Pediatrics and Medicine, Washington University School of Medicine, St. Louis, MO
| | - Robert J Adams
- Department of Neurology, Medical University of South Carolina, Charleston, SC
| | | | - Amanda M Brandow
- Pediatric Hematology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, TN
| | - Manus J Donahue
- Department of Radiology and Radiological Sciences
- Department of Neurology, and
- Department of Psychiatry, School of Medicine, Vanderbilt University, Nashville, TN
| | - Kalpna Gupta
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, Medical School, University of Minnesota, Minneapolis, MN
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Fenella J Kirkham
- Developmental Neurosciences Unit and
- Biomedical Research Unit, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Harvey Luksenburg
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | | | | | - David C Rees
- Department of Haematological Medicine, King's College Hospital, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London, London, United Kingdom
| | | | - Vivien A Sheehan
- Division of Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - John Strouse
- Division of Hematology, Department of Medicine, and
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Cheryl L Stucky
- Department of Cell Biology, Neurobiology, and Anatomy, Medical College of Wisconsin, Milwaukee, WI
| | - Ellen M Werner
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - John C Wood
- Children's Hospital Los Angeles, Los Angeles, CA; and
| | - William T Zempsky
- Department of Pediatrics, Connecticut Children's/School of Medicine, University of Connecticut, Hartford, CT
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20
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Khoo MCK, Chalacheva P. Respiratory modulation of peripheral vasoconstriction: a modeling perspective. J Appl Physiol (1985) 2019; 127:1177-1186. [DOI: 10.1152/japplphysiol.00111.2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Although respiratory sinus arrhythmia and blood pressure variability have been investigated extensively, there have been far fewer studies of the respiratory modulation of peripheral blood flow in humans. Existing studies have been based primarily on noninvasive measurements using digit photoplethysmography and laser-Doppler flowmetry. The cumulative knowledge derived from these studies suggests that respiration can contribute to fluctuations in peripheral blood flow and volume through a combination of mechanical, hemodynamic, and neural mechanisms. However, the most convincing evidence suggests that the sympathetic nervous system plays the predominant role under normal, resting conditions. This mini-review provides a consolidation and interpretation of the key findings reported in this topical area. Given the need to extract dynamic information from noninvasive measurements under largely “closed-loop” conditions, we propose that the application of analytical tools based on systems theory and mathematical modeling can be of great utility in future studies. In particular, we present an example of how the transfer relation linking respiration to peripheral vascular conductance can be derived using measurements recorded during spontaneous breathing, spontaneous sighs, and ventilator-induced sighs.
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Affiliation(s)
- Michael C. K. Khoo
- Biomedical Engineering Department, University of Southern California, Los Angeles, California
| | - Patjanaporn Chalacheva
- Biomedical Engineering Department, University of Southern California, Los Angeles, California
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21
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Veluswamy S, Shah P, Denton CC, Chalacheva P, Khoo MCK, Coates TD. Vaso-Occlusion in Sickle Cell Disease: Is Autonomic Dysregulation of the Microvasculature the Trigger? J Clin Med 2019; 8:jcm8101690. [PMID: 31618931 PMCID: PMC6832215 DOI: 10.3390/jcm8101690] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 02/02/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by polymerization of hemoglobin S upon deoxygenation that results in the formation of rigid sickled-shaped red blood cells that can occlude the microvasculature, which leads to sudden onsets of pain. The severity of vaso-occlusive crises (VOC) is quite variable among patients, which is not fully explained by their genetic and biological profiles. The mechanism that initiates the transition from steady state to VOC remains unknown, as is the role of clinically reported triggers such as stress, cold and pain. The rate of hemoglobin S polymerization after deoxygenation is an important determinant of vaso-occlusion. Similarly, the microvascular blood flow rate plays a critical role as fast-moving red blood cells are better able to escape the microvasculature before polymerization of deoxy-hemoglobin S causes the red cells to become rigid and lodge in small vessels. The role of the autonomic nervous system (ANS) activity in VOC initiation and propagation has been underestimated considering that the ANS is the major regulator of microvascular blood flow and that most triggers of VOC can alter the autonomic balance. Here, we will briefly review the evidence supporting the presence of ANS dysfunction in SCD, its implications in the onset of VOC, and how differences in autonomic vasoreactivity might potentially contribute to variability in VOC severity.
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Affiliation(s)
- Saranya Veluswamy
- Hematology Section, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, 4650 Sunset boulevard, Los Angeles, CA 90027, USA; (S.V.); (P.S.); (C.C.D.)
| | - Payal Shah
- Hematology Section, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, 4650 Sunset boulevard, Los Angeles, CA 90027, USA; (S.V.); (P.S.); (C.C.D.)
| | - Christopher C. Denton
- Hematology Section, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, 4650 Sunset boulevard, Los Angeles, CA 90027, USA; (S.V.); (P.S.); (C.C.D.)
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA; (P.C.)
| | - Michael C. K. Khoo
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, USA; (P.C.)
| | - Thomas D. Coates
- Hematology Section, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, 4650 Sunset boulevard, Los Angeles, CA 90027, USA; (S.V.); (P.S.); (C.C.D.)
- Correspondence: ; Tel.: +1-323-361-2352
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22
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23
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Shah P, Khaleel M, Thuptimdang W, Sunwoo J, Veluswamy S, Chalacheva P, Kato RM, Detterich J, Wood JC, Zeltzer L, Sposto R, Khoo MCK, Coates TD. Mental stress causes vasoconstriction in subjects with sickle cell disease and in normal controls. Haematologica 2019; 105:83-90. [PMID: 30975906 PMCID: PMC6939522 DOI: 10.3324/haematol.2018.211391] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/05/2019] [Indexed: 01/02/2023] Open
Abstract
Vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD) and occurs when deoxygenated sickled red blood cells occlude the microvasculature. Any stimulus, such as mental stress, which decreases microvascular blood flow will increase the likelihood of red cell entrapment resulting in local vaso-occlusion and progression to VOC. Neurally mediated vasoconstriction might be the physiological link between crisis triggers and vaso-occlusion. In this study, we determined the effect of mental stress on microvascular blood flow and autonomic nervous system reactivity. Sickle cell patients and controls performed mentally stressful tasks, including a memory task, conflict test and pain anticipation test. Blood flow was measured using photoplethysmography, autonomic reactivity was derived from electrocardiography and perceived stress was measured by the State-Trait Anxiety Inventory questionnaire. Stress tasks induced a significant decrease in microvascular blood flow, parasympathetic withdrawal and sympathetic activation in all subjects. Of the various tests, pain anticipation caused the highest degree of vasoconstriction. The magnitude of vasoconstriction, sympathetic activation and perceived stress was greater during the Stroop conflict test than during the N-back memory test, indicating the relationship between magnitude of experimental stress and degree of regional vasoconstriction. Baseline anxiety had a significant effect on the vasoconstrictive response in sickle cell subjects but not in controls. In conclusion, mental stress caused vasoconstriction and autonomic nervous system reactivity in all subjects. Although the pattern of responses was not significantly different between the two groups, the consequences of vasoconstriction can be quite significant in SCD because of the resultant entrapment of sickle cells in the microvasculature. This suggests that mental stress can precipitate a VOC in SCD by causing neural-mediated vasoconstriction.
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Affiliation(s)
- Payal Shah
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Maha Khaleel
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Wanwara Thuptimdang
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - John Sunwoo
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Saranya Veluswamy
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Patjanaporn Chalacheva
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Roberta M Kato
- Division of Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Jon Detterich
- Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - John C Wood
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles.,Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Lonnie Zeltzer
- Pediatric Pain Program, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA
| | - Richard Sposto
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael C K Khoo
- Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles
| | - Thomas D Coates
- Division of Hematology, Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
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Chalacheva P, Kato RM, Shah P, Veluswamy S, Denton CC, Sunwoo J, Thuptimdang W, Wood JC, Detterich JA, Coates TD, Khoo MCK. Sickle Cell Disease Subjects Have a Distinct Abnormal Autonomic Phenotype Characterized by Peripheral Vasoconstriction With Blunted Cardiac Response to Head-Up Tilt. Front Physiol 2019; 10:381. [PMID: 31031633 PMCID: PMC6470196 DOI: 10.3389/fphys.2019.00381] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/19/2019] [Indexed: 12/26/2022] Open
Abstract
In sickle cell disease (SCD), prolonged capillary transit times, resulting from reduced peripheral blood flow, increase the likelihood of rigid red cells entrapment in the microvasculature, predisposing to vaso-occlusive crisis. Since changes in peripheral flow are mediated by the autonomic nervous system (ANS), we tested the hypothesis that the cardiac and peripheral vascular responses to head-up tilt (HUT) are abnormal in SCD. Heart rate, respiration, non-invasive continuous blood pressure and finger photoplethysmogram (PPG) were monitored before, during, and after HUT in SCD, anemic controls and healthy subjects. Percent increase in heart rate from baseline was used to quantify cardiac ANS response, while percent decrease in PPG amplitude represented degree of peripheral vasoconstriction. After employing cluster analysis to determine threshold levels, the HUT responses were classified into four phenotypes: (CP) increased heart rate and peripheral vasoconstriction; (C) increased heart rate only; (P) peripheral vasoconstriction only; and (ST) subthreshold cardiac and peripheral vascular responses. Multinomial logistic regression (MLR) was used to relate these phenotypic responses to various parameters representing blood properties and baseline cardiovascular activity. The most common phenotypic response, CP, was found in 82% of non-SCD subjects, including those with chronic anemia. In contrast, 70% of SCD subjects responded abnormally to HUT: C-phenotype = 22%, P-phenotype = 37%, or ST-phenotype = 11%. MLR revealed that the HUT phenotypes were significantly associated with baseline cardiac parasympathetic activity, baseline peripheral vascular variability, hemoglobin level and SCD diagnosis. Low parasympathetic activity at baseline dramatically increased the probability of belonging to the P-phenotype in SCD subjects, even after adjusting for hemoglobin level, suggesting a characteristic autonomic dysfunction that is independent of anemia. Further analysis using a mathematical model of heart rate variability revealed that the low parasympathetic activity in P-phenotype SCD subjects was due to impaired respiratory-cardiac coupling rather than reduced cardiac baroreflex sensitivity. By having strong peripheral vasoconstriction without compensatory cardiac responses, P-phenotype subjects may be at increased risk for vaso-occlusive crisis. The classification of autonomic phenotypes based on HUT response may have potential use for guiding therapeutic interventions to alleviate the risk of adverse outcomes in SCD.
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Affiliation(s)
- Patjanaporn Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Roberta M Kato
- Divisions of Pulmonology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Payal Shah
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Saranya Veluswamy
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Christopher C Denton
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - John Sunwoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - Wanwara Thuptimdang
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
| | - John C Wood
- Divisions of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Jon A Detterich
- Divisions of Cardiology, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Thomas D Coates
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Michael C K Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, United States
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Sunwoo J, Chalacheva P, Khaleel M, Shah P, Sposto R, Kato RM, Detterich J, Zeltzer LK, Wood JC, Coates TD, Khoo MC. A novel cross-correlation methodology for assessing biophysical responses associated with pain. J Pain Res 2018; 11:2207-2219. [PMID: 30323655 PMCID: PMC6179586 DOI: 10.2147/jpr.s142582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose The purpose of this work was to noninvasively detect and quantify microvascular blood flow changes in response to externally applied pain in humans. The responsiveness of the microvasculature to pain stimulation might serve as an objective biomarker in diseases associated with altered pain perception and dysregulated vascular functions. The availability of such a biomarker may be useful as a tool for predicting outcome and response to treatments, particularly in diseases like sickle cell anemia where clinical manifestations are directly linked to microvascular perfusion. We, therefore, developed a method to distinguish the blood flow response due to the test stimulus from the blood flow measurement that also includes concurrent flow changes from unknown origins. Subjects and methods We measured the microvascular blood flow response in 24 healthy subjects in response to a train of randomly spaced and scaled heat pulses on the anterior forearm. The fingertip microvascular perfusion was measured using laser Doppler flowmetry. The cross-correlation between the heat pulses and the blood flow response was computed and tested for significance against the null distribution obtained from the baseline recording using bootstrapping method. Results We estimated correlation coefficients, response time, response significance, and the magnitude of vasoreactivity from microvascular blood flow responses. Based on these pain response indices, we identified strong responders and subjects who did not show significant responses. Conclusion The cross-correlation of a random pattern of painful stimuli with directly measured microvascular flow can detect vasoconstriction responses in a noisy blood flow signal, determine the time between stimulus and response, and quantify the magnitude of this response. This approach provided an objective measurement of vascular response to pain that may be an inherent characteristic of individual human subjects, and may also be related to the severity of vascular disorders.
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Affiliation(s)
- John Sunwoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA,
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA,
| | - Maha Khaleel
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Payal Shah
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Richard Sposto
- Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Roberta M Kato
- Division of Pediatric Pulmonology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon Detterich
- Division of Pediatric Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lonnie K Zeltzer
- Pediatric Pain and Palliative Care Program, Department of Pediatrics, Division of Hematology-Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - John C Wood
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA, .,Division of Pediatric Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Thomas D Coates
- Hematology Section, Children's Center for Cancer, Blood Disease and Bone Marrow Transplantation, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael Ck Khoo
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA,
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26
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Coates TD, Chalacheva P, Zeltzer L, Khoo MC. Autonomic nervous system involvement in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:251-262. [DOI: 10.3233/ch-189011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Thomas D. Coates
- Section of Hematology, Children’s Center for Cancer and Blood Diseases, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Patjanaporn Chalacheva
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Lonnie Zeltzer
- Department of Pediatrics, Pediatric Pain and Palliative Care Program Division of Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Michael C.K. Khoo
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
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27
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Targeting novel mechanisms of pain in sickle cell disease. Blood 2017; 130:2377-2385. [PMID: 29187376 DOI: 10.1182/blood-2017-05-782003] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/23/2017] [Indexed: 11/20/2022] Open
Abstract
Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vaso-occlusive crises (VOCs) characterized by episodic, recurrent, and unpredictable episodes of acute pain. Microvascular obstruction during a VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress, and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents up-to-date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of "top-down" mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD.
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28
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Tran H, Gupta M, Gupta K. Targeting novel mechanisms of pain in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:546-555. [PMID: 29222304 PMCID: PMC6142592 DOI: 10.1182/asheducation-2017.1.546] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Patients with sickle cell disease (SCD) suffer from intense pain that can start during infancy and increase in severity throughout life, leading to hospitalization and poor quality of life. A unique feature of SCD is vaso-occlusive crises (VOCs) characterized by episodic, recurrent, and unpredictable episodes of acute pain. Microvascular obstruction during a VOC leads to impaired oxygen supply to the periphery and ischemia reperfusion injury, inflammation, oxidative stress, and endothelial dysfunction, all of which may perpetuate a noxious microenvironment leading to pain. In addition to episodic acute pain, patients with SCD also report chronic pain. Current treatment of moderate to severe pain in SCD is mostly reliant upon opioids; however, long-term use of opioids is associated with multiple side effects. This review presents up-to-date developments in our understanding of the pathobiology of pain in SCD. To help focus future research efforts, major gaps in knowledge are identified regarding how sickle pathobiology evokes pain, pathways specific to chronic and acute sickle pain, perception-based targets of "top-down" mechanisms originating from the brain and neuromodulation, and how pain affects the sickle microenvironment and pathophysiology. This review also describes mechanism-based targets that may help develop novel therapeutic and/or preventive strategies to ameliorate pain in SCD.
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Affiliation(s)
- Huy Tran
- Vascular Biology Center, Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
| | - Mihir Gupta
- Department of Neurosurgery, University of California San Diego, La Jolla, CA
| | - Kalpna Gupta
- Vascular Biology Center, Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN; and
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