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Target Concepts:
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Query: UMLS:C0184567 (
acute pain
)
3,962
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
Sickle cell disease is a uniquely complex painful disease, with lifelong episodes of unpredictable
acute pain
and superimposed chronic pain in adulthood. Both painful crises and chronic pain in sickle cell disease lack strong objective pathological correlates and their mechanisms are poorly understood. Opioids have emerged as the standard of care for severe
acute pain
in sickle cell disease and many patients with chronic pain are maintained on chronic opioid therapy. The strong association between recurrent
acute pain
and chronic pain in
SCD
blurs the distinction between acute and chronic opioid management paradigms. In addition, opioid management for
SCD
is dogged by stigma and concerns regarding addiction. This review aims to synthesize the broad literature on opioids to highlight the clinical complexity of opioid management in sickle cell disease and suggest directions for future research and clinical innovation.
...
PMID:Opioid treatment for acute and chronic pain in patients with sickle cell disease. 3159 53
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 (M
vasoc
), duration, and frequency of vasoconstriction that reflect the individual's inherent peripheral vasoreactivity. The propensity to vasoconstrict, quantified by median M
vasoc
, 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 M
vasoc
but did not predict future pain rate. Median M
vasoc
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.
...
PMID:Nocturnal peripheral vasoconstriction predicts the frequency of severe acute pain episodes in children with sickle cell disease. 3302 45
