Pain and sickle cell disease

Anupam Aich, Michael K. Jones, Kalpna Gupta

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Purpose of reviewPain is a major comorbidity of sickle cell disease (SCD). Opioids are the mainstay for pain treatment but remain suboptimal. We discuss mechanism-based treatable targets devoid of opioids to prevent and/or treat SCD pain.Recent findingsUnderstanding the pathogenesis of pain is critical to develop targeted therapies. Nevertheless, acute and chronic pain can have independent and/or overlapping mechanisms. The origin of pain involves neurovascular and neuroimmune interactions from the periphery and/or central nervous system. Immunomodulatory components of acute and/or chronic sickle pain for targeting/preventing pain genesis include mast cell and microglial activation, neurogenic inflammation, and leukocyte-derived elastase. Vascular modulators include hypoxia/reperfusion injury, oxidative stress, hemolysis, and adhesion molecules. However, existent pain requires analgesics devoid of an inadvertent effect on sickle pathobiology. Recent analgesic targets include cannabinoid and nociceptin receptors and serotonergic spinothalamic pathway. Complementary approaches (e.g., acupuncture, hypnosis, perception-based therapies) have shown analgesic potential. Owing to heterogeneity in pain development, it remains challenging to combat SCD pain with any one therapy.SummarySCD pain involves neuroimmune and neurovascular interactions. Such interactions have pronociceptive impacts and impart therapy resistance. Elucidating molecular and cellular entities affecting neuronal interactions in sickle microenvironment may prevent SCD pain and/or provide improved analgesic approaches.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalCurrent opinion in hematology
Volume26
Issue number3
DOIs
StatePublished - May 1 2019

Bibliographical note

Funding Information:
This study was funded by National Heart, Lung, and Blood Institute (grant number UO1HL117664).

Keywords

  • elastase
  • mast cells
  • neuroimmune interaction
  • sickle pain
  • vasoocclusion

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