Pain-measurement tools in sickle cell disease: where are we now?

Abstract

Pain is a complex multidimensional experience and the most common morbidity in patients with sickle cell disease (SCD). Tools to assess pain can be of use not only to guide pain treatment but also to provide insight into underlying pain neurobiology. Mechanisms of pain in SCD are multifactorial and are not completely elucidated. Although vaso-occlusion of microcirculation by sickled red cells is believed to be the underlying mechanism of acute vaso-occlusive pain, mechanisms for chronic pain and the transition from acute to chronic pain are under investigation. A number of modalities can be used in clinical practice and/or research to capture various dimensions of pain. Selection of a pain-assessment tool should be directed by the purpose of the assessment. Pain-assessment tools, many of which are currently in the early stages of validation, are discussed here. Development and validation of these multimodal tools is crucial for developing improved understanding of SCD pain and its management.

Figure 1.

Conceptual framework for pain measurement in patients with SCD. the measurement of pain in SCD patients of has 3 main components: unidimensional measurement of pain intensity, multidimensional measurement of pain impact, and multidimensional measures of pain biology. The specific measures in each category and their utility are depicted.