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Precision, integrative medicine for pain management in sickle cell disease

Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debi...

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Autores principales: Smith, Wally R., Valrie, Cecelia R., Jaja, Cheedy, Kenney, Martha O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666191/
https://www.ncbi.nlm.nih.gov/pubmed/38028431
http://dx.doi.org/10.3389/fpain.2023.1279361
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author Smith, Wally R.
Valrie, Cecelia R.
Jaja, Cheedy
Kenney, Martha O.
author_facet Smith, Wally R.
Valrie, Cecelia R.
Jaja, Cheedy
Kenney, Martha O.
author_sort Smith, Wally R.
collection PubMed
description Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack’s neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model.
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spelling pubmed-106661912023-11-09 Precision, integrative medicine for pain management in sickle cell disease Smith, Wally R. Valrie, Cecelia R. Jaja, Cheedy Kenney, Martha O. Front Pain Res (Lausanne) Pain Research Sickle cell disease (SCD) is a prevalent and complex inherited pain disorder that can manifest as acute vaso-occlusive crises (VOC) and/or chronic pain. Despite their known risks, opioids are often prescribed routinely and indiscriminately in managing SCD pain, because it is so often severe and debilitating. Integrative medicine strategies, particularly non-opioid therapies, hold promise in safe and effective management of SCD pain. However, the lack of evidence-based methods for managing SCD pain hinders the widespread implementation of non-opioid therapies. In this review, we acknowledge that implementing personalized pain treatment strategies in SCD, which is a guideline-recommended strategy, is currently fraught with limitations. The full implementation of pharmacological and biobehavioral pain approaches targeting mechanistic pain pathways faces challenges due to limited knowledge and limited financial and personnel support. We recommend personalized medicine, pharmacogenomics, and integrative medicine as aspirational strategies for improving pain care in SCD. As an organizing model that is a comprehensive framework for classifying pain subphenotypes and mechanisms in SCD, and for guiding selection of specific strategies, we present evidence updating pain research pioneer Richard Melzack’s neuromatrix theory of pain. We advocate for using the updated neuromatrix model to subphenotype individuals with SCD, to better select personalized multimodal treatment strategies, and to identify research gaps fruitful for exploration. We present a fairly complete list of currently used pharmacologic and non-pharmacologic SCD pain therapies, classified by their mechanism of action and by their hypothesized targets in the updated neuromatrix model. Frontiers Media S.A. 2023-11-09 /pmc/articles/PMC10666191/ /pubmed/38028431 http://dx.doi.org/10.3389/fpain.2023.1279361 Text en © 2023 Smith, Valrie, Jaja and Kenney. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pain Research
Smith, Wally R.
Valrie, Cecelia R.
Jaja, Cheedy
Kenney, Martha O.
Precision, integrative medicine for pain management in sickle cell disease
title Precision, integrative medicine for pain management in sickle cell disease
title_full Precision, integrative medicine for pain management in sickle cell disease
title_fullStr Precision, integrative medicine for pain management in sickle cell disease
title_full_unstemmed Precision, integrative medicine for pain management in sickle cell disease
title_short Precision, integrative medicine for pain management in sickle cell disease
title_sort precision, integrative medicine for pain management in sickle cell disease
topic Pain Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666191/
https://www.ncbi.nlm.nih.gov/pubmed/38028431
http://dx.doi.org/10.3389/fpain.2023.1279361
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