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Bertram W, Howells N, White SP, Sanderson E, Wylde V, Lenguerrand E, Gooberman-Hill R, Bruce J. Prevalence and patterns of neuropathic pain in people with chronic post-surgical pain after total knee arthroplasty. Bone Joint J 2024; 106-B:582-588. [PMID: 38821515 DOI: 10.1302/0301-620x.106b6.bjj-2023-0889.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
Aims The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA). Methods Between 2016 and 2019, 363 patients with troublesome pain, defined as a score of ≤ 14 on the Oxford Knee Score pain subscale, three months after TKA from eight UK NHS hospitals, were recruited into the Support and Treatment After Replacement (STAR) clinical trial. Self-reported neuropathic pain and postoperative pain was assessed at three, nine, and 15 months after surgery using the painDETECT and Douleur Neuropathique 4 (DN4) questionnaires collected by postal survey. Results Symptoms of neuropathic pain were common among patients reporting chronic pain at three months post-TKA, with half reporting neuropathic pain on painDETECT (191/363; 53%) and 74% (267/359) on DN4. Of those with neuropathic pain at three months, half continued to have symptoms over the next 12 months (148/262; 56%), one-quarter had improved (67/262; 26%), and for one-tenth their neuropathic symptoms fluctuated over time (24/262; 9%). However, a subgroup of participants reported new, late onset neuropathic symptoms (23/262; 9%). Prevalence of neuropathic symptoms was similar between the screening tools when the lower cut-off painDETECT score (≥ 13) was applied. Overall, mean neuropathic pain scores improved between three and 15 months after TKA. Conclusion Neuropathic pain is common in patients with chronic pain at three months after TKA. Although neuropathic symptoms improved over time, up to half continued to report painful neuropathic symptoms at 15 months after TKA. Postoperative care should include screening, assessment, and treatment of neuropathic pain in patients with early chronic postoperative pain after TKA.
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Affiliation(s)
- Wendy Bertram
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | | | - Simon P White
- Cardiff and Vale University Health Board, Cardiff, UK
| | | | - Vikki Wylde
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Erik Lenguerrand
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK
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Rees M, Spraker‐Perlman H, Moore R, Lavoie P, Schiff L, Allen JM, Rai P, Anghelescu DL. Patient and clinician beliefs about potential barriers to treatment of neuropathic pain for adolescents with sickle cell disease. EJHAEM 2024; 5:11-20. [PMID: 38406507 PMCID: PMC10887355 DOI: 10.1002/jha2.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/19/2023] [Accepted: 11/08/2023] [Indexed: 02/27/2024]
Abstract
Pain is the hallmark symptom causing morbidity for people with sickle cell disease (SCD) and may present as nociceptive, neuropathic, or mixed type pain. Neuropathic pain (NP) is underrecognized and undertreated in patients with SCD and is associated with decreased patient-reported quality of life. Surveys were completed by clinicians caring for adolescents with SCD in the outpatient setting. SCD patients ages 1418 at increased risk of NP completed a patient-facing survey at a scheduled clinic visit. Ninety-four percent of responding clinicians agreed that NP significantly contributes to reported pain in SCD. Clinicians believed that NP medications are effective for reducing chronic pain (62%) and decreasing opioid utilization (44%). Clinician-identified barriers to prescribing NP medications included concerns about medication adherence (82%), lack of pediatric guidelines for NP medications (70%), and perceived patient concern about side effects (65%). More than 1/3 (35%) of clinicians reported that they were not comfortable managing NP medications. Clinician-identified barriers to referral to a pain management specialist included scheduling concerns (88%) and perceived patient/family lack of interest (77%). Most patients expressed willingness to take a medication for NP (78%), see a pain management specialist (84%), or learn more about nonpharmacologic interventions (72%), although most (51%) also reported some concerns about taking a medication for NP, citing insufficient knowledge (34%), and potential for side effects (32%). A minority of respondents (15%) worried about referral to a pain management specialist. Clinician and patient perspectives provide insights that may guide education efforts or other interventions to improve treatment of SCD-related NP.
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Affiliation(s)
- Matthew Rees
- Department of OncologySt Jude Children's Research HospitalMemphisTennesseeUSA
| | | | - Raechyl Moore
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Paul Lavoie
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Linda Schiff
- Department of Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jennifer M. Allen
- Department of PsychologySt. Louis Children's HospitalSt LouisMissouriUSA
| | - Parul Rai
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Doralina L. Anghelescu
- Department of Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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Cregan M, Puri L, Kang G, Anghelescu D. Prevalence of neuropathic pain in adolescents with sickle cell disease: A single-center experience. Pediatr Blood Cancer 2022; 69:e29583. [PMID: 35147289 PMCID: PMC8860881 DOI: 10.1002/pbc.29583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 01/15/2023]
Abstract
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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Affiliation(s)
- Melissa Cregan
- St. Jude Children’s Research Hospital, Memphis, TN, USA, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | - Guolian Kang
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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Ramsay Z, Bartlett R, Ali A, Grant J, Gordon-Strachan G, Asnani M. Sickle Cell Disease and Pain: Is it all Vaso-occlusive Crises? Clin J Pain 2021; 37:583-590. [PMID: 34008506 DOI: 10.1097/ajp.0000000000000949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute pain is the main complication of sickle cell disease. Chronic pain (CP) and neuropathic pain (NP) 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. MATERIALS AND METHODS All well individuals with sickle cell disease patients 14 years and older, not pregnant and without a history of clinical stroke were consecutively recruited. Anthropometric measurements, hematology studies, an analgesia checklist, and the Adult Sickle Cell Quality of Life Measurement Information System questionnaire were completed. The painDETECT questionnaire was completed to describe NP and pain patterns-from which CP was defined. RESULTS There were 257 patients in total, with 55.6% being females; the mean age of the patients was 31.7±12 years, and 75% had the SS genotype. Almost all patients (92.6%) had 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 prevalences of CP and NP were 21.5% and 17.9%, respectively. Female sex, the presence of current leg ulcers, and the use of a strong opioid in the last 4 weeks produced higher odds of NP, whereas older age, milder genotypes, and daily analgesic use had the highest odds of CP. Opioids were used by 40.1% of the patients in the previous 4 weeks, whereas nonpharmacological treatments such as physiotherapy was less used, but reported to be very effective. DISCUSSION CP and NP should be assessed during routine care of sickle cell pain so that targeted therapies can be applied.
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Affiliation(s)
- Zachary Ramsay
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
| | - Rachel Bartlett
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
| | - Amza Ali
- Department of Medicine, Kingston Public Hospital, Kingston, Jamaica
| | | | | | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the West Indies
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Phenotyping peripheral neuropathic pain in male and female adolescents: pain descriptors, somatosensory profiles, conditioned pain modulation, and child-parent reported disability. Pain 2021; 162:1732-1748. [PMID: 33394878 DOI: 10.1097/j.pain.0000000000002172] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/09/2020] [Indexed: 12/13/2022]
Abstract
ABSTRACT Neuropathic pain (NeuP) can be difficult to diagnose and manage in children. Data regarding prevalence and sex-dependent differences are limited, and more detailed phenotyping is needed. This observational cohort study recruited adolescents (10-17 years) with NeuP or complex regional pain syndrome (CRPS). After pain history and NeuP questionnaires, quantitative sensory testing was performed. Individual z-score plots were calculated with body-region control measures and matched to mechanism-related sensory profiles (sensory loss, thermal hyperalgesia, and mechanical hyperalgesia). Conditioned pain modulation was assessed with pressure pain threshold and a contralateral cold conditioning stimulus, and meaningful conditioned pain modulation defined as twice the standard error of measurement. Patients and parents completed validated questionnaires for child quality of life (QoL), pain catastrophizing, and self-reported anxiety/depression. Males (n = 23) and females (n = 43) with NeuP (n = 52) or CRPS (n = 14) reported moderate-severe pain with neuropathic sensory descriptors. Mixed patterns of sensory gain/loss at pain sites were not sex-dependent. Thermal hyperalgesia was common in both NeuP and CRPS, whereas sensory loss occurred only with NeuP and in a smaller proportion than adult cohorts. Conditioned pain modulation was inhibitory in 54%, facilitatory in 14%, and nonresponders had variable cold conditioning sensitivity. Males and females reported marked impairment of QoL, increased emotional distress, and pain catastrophising. Child-parent QoL scores correlated, but catastrophizing scores were discordant when parents or adolescents reported higher anxiety/depression. NeuP in adolescents is associated with significant pain, physical impairment, and psychosocial impairment. Quantifying alterations in somatosensory profiles, descending modulation, child and parent psychological function will inform individualized therapy and stratification for future clinical trials.
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Bartlett R, Ramsay Z, Ali A, Grant J, Rankine-Mullings A, Gordon-Strachan G, Asnani M. Health-related quality of life and neuropathic pain in sickle cell disease in Jamaica. Disabil Health J 2021; 14:101107. [PMID: 33867318 DOI: 10.1016/j.dhjo.2021.101107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health related quality of Life (HRQOL) is an important consideration when managing chronic diseases, like sickle cell disease (SCD). Assessment of neuropathic pain (NP) and its association with HRQOL in SCD are rarely reported. OBJECTIVES To examine the prevalence of NP and its association with HRQOL in adult Jamaicans with SCD. METHODS Adult SCD patients were recruited consecutively and data were collected on socio-demographics, NP using Douleur Neuropathique 4 (DN4), and HRQOL using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). Means, medians, t-tests, ANOVA tests, Wilcoxon Rank-sum tests, Kruskal-Wallis tests, Pearson's correlation and multivariate linear regression analyses were performed using STATA 14.2. RESULTS There were 236 respondents, with 56.8% female, mean age 33.2 years (SD: 11.6; range: 18-67 years), and 75% had homozygous SS genotype. NP was likely present in 26.7% of the population. The standardized ASCQ-Me (mean ± SD; ordered from lowest to best HRQOL domain scores) were: emotional impact 53.3 ± 10.1; sleep impact 56.1 ± 9.7; social function 57.7 ± 10.6; pain impact 58.6 ± 7.8; and stiffness impact 61.0 ± 7.3. On multivariate analyses, NP significantly reduced emotional and social functioning and worsened sleep and stiffness. Higher acute pain scores significantly worsened all HRQOL domains, while higher disease severity worsened all except stiffness. Obesity was associated with worse sleep and greater stiffness. Females with leg ulcers reported lower social functioning and unemployed females had greater pain impact. CONCLUSIONS NP is increasingly prevalent in SCD and worsens HRQOL. Gender specific studies are needed to understand the significantly poorer HRQOL in women.
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Affiliation(s)
- Rachel Bartlett
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Zachary Ramsay
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Amza Ali
- Avicanna Inc., 480 University Ave, Suite 1502, Toronto, ON M5G 1V2, Canada; Department of Medicine, Kingston Public Hospital, Kingston, Jamaica
| | - Justin Grant
- Avicanna Inc., 480 University Ave, Suite 1502, Toronto, ON M5G 1V2, Canada
| | - Angela Rankine-Mullings
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Georgiana Gordon-Strachan
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - Monika Asnani
- Caribbean Institute for Health Research, The University of the West Indies, Mona Campus, Kingston 7, Jamaica.
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Sigalla J, Duparc Alegria N, Le Roux E, Toumazi A, Thiollier AF, Holvoet L, Benkerrou M, Dugue S, Koehl B. Neuropathic Pain in Children with Sickle Cell Disease: The Hidden Side of the Vaso-Occlusive Crisis. CHILDREN-BASEL 2021; 8:children8020084. [PMID: 33530318 PMCID: PMC7911240 DOI: 10.3390/children8020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/15/2021] [Accepted: 01/21/2021] [Indexed: 11/16/2022]
Abstract
The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient's age, sex, and clinical presentation.
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Affiliation(s)
- Jeanne Sigalla
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Nathalie Duparc Alegria
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Enora Le Roux
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
| | - Artemis Toumazi
- Unité d’Épidémiologie Clinique, Inserm, CIC 1426, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France; (E.L.R.); (A.T.)
| | - Anne-Françoise Thiollier
- Pain Management Unit, Hôpital Robert Debré, APHP, F-75019 Paris, France; (J.S.); (N.D.A.); (A.-F.T.)
| | - Laurent Holvoet
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Malika Benkerrou
- Université de Paris, ECEVE UMR 1123, Inserm, F-75010 Paris, France;
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
| | - Sophie Dugue
- Pain Management Unit, Trousseau Hospital, AP-HP, Sorbonne Université, F-75012 Paris, France;
| | - Berengere Koehl
- Department of Hematology, Reference Center of Sickle Cell Disease, Hôpital Universitaire Robert Debré, AP-HP, Nord-Université de Paris, F-75019 Paris, France;
- INSERM UMRS 1134, Red Blood Cell Pathophysiology, F-75015 Paris, France
- Correspondence:
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Rasche T, Emmert D, Seidel H, Sellin J, Conrad R, Mücke M. [Pain management in sickle cell disease]. Schmerz 2020; 34:285-296. [PMID: 32367470 DOI: 10.1007/s00482-020-00465-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is associated with numerous symptoms and complications. Acute painful crisis is the most characteristic manifestation of the disease. In addition, many patients report chronic pain. As both acute and chronic pain severely diminish quality of life, adequate pain management is crucial. Recommendations for the treatment of acute painful crises are based on the World Health Organization analgesic ladder, which has been developed for cancer-related pain. Chronic pain can be treated with basic long-acting opioids and on-demand short-acting opioids. If patients show signs of neuropathic pain, administration of anticonvulsants, antidepressants or possibly ketamine should be considered.
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Affiliation(s)
- T Rasche
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - D Emmert
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - H Seidel
- Centrum für Blutgerinnungsstörungen und Transfusionsmedizin (CBT), Bonn, Deutschland
| | - J Sellin
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland
| | - R Conrad
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - M Mücke
- Zentrum für seltene Erkrankungen (ZSEB), Universitätsklinikum Bonn, Venusberg Campus 1, 53127, Bonn, Deutschland.
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