Acute & Chronic Pain
Pain is one the biggest challenges for individuals with sickle cell disease. Understanding the difference between acute and chronic pain and the different sources of pain is important to help you identify life-threatening causes and improve your quality of life.
Acute Pain
Acute pain will be very severe in quality and come on very quickly. A common cause of this type of pain is a vaso-occlusive crisis, which is a blockage in the blood supply of an organ or tissue. Sickle cells are more likely to block blood vessels and individuals with SCD are more likely to form clots in general. Pain episodes are often linked to triggers such as cold, dehydration, alcohol, or stress. Vaso-occlusive crises require treatment by a medical professional who will be able to administer IV fluids, pain medications, and transfusions if needed.
The bones can also be affected by sickle cell disease. Dactylitis is a blockage of vessels in the small bones of the hand and feet which causes severe pain. The fingers and toes can also become swollen and resemble “sausages”. Dactylitis is most common in children. You can treat dactylitis pain episodes using over the counter pain medications like ibuprofen and warming the fingers and toes. It is also important to stay hydrated by drinking enough water during these episodes.
Chronic pain
Chronic pain refers to pain that persists over 3 months or more. Chronic pain can feel like throbbing, wrenching, tearing, pulsing, piercing, crushing, cramping, aching, cold, hot, penetrating, shooting, and stabbing. Chronic pain can also affect one area of the body or be widespread and affect multiple areas of the body.
The best treatment for pain depends on the type of pain that you have. These videos can help you understand your pain and what might be causing it.
Pain Mechanisms
There are three mechanisms that can give rise to the perception of pain. Below is a description of each type of pain.
Nociceptive pain
Nociceptive pain is an example of the body’s pain mechanism working properly and adaptively. It warns you of threat and danger. Examples include pain stemming from acute injury, pain after surgery, and pain associated with tumors. Short-term inflammatory pain is another example of adaptive pain, where the immune system warns of danger by causing inflammation which can be interpreted by the brain as being painful. Most forms of nociceptive pain are short lived and serve a motivational function to urge you to act in accordance with health, safety, and survival.
Neuropathic pain
Neuropathic pain refers to pain associated with damage to either the peripheral or central nervous system. These nervous systems help take nociceptive messages from a site of injury to the brain. If the nerves carrying messages to the brain get damaged, they may fire excessively or in abnormal patterns. The excessive firing or abnormal firing patterns can be interpreted by the brain as sharp or burning pain. Neuropathic pain is a pain disorder that has lost its adaptive function. Examples include diabetic neuropathy, severed nerves, and nerve damage to the brain or spinal cord.
Nociplastic pain
Nociplastic pain or “centrally augmented pain” is a disorder of how the brain processes nociceptive signals. In such cases, non-nociceptive or minimally nociceptive signals from the body can become augmented by the brain leading to the production of a painful experience. It should be noted that pain experienced in response to an injury is indistinguishable from pain associated with central augmentation. Both are “real” forms of pain, and both can result in comparable levels of suffering. Many factors can contribute to central pain augmentation including genetics, infections, hormonal abnormalities, physical and/or psychological trauma, repetitive injuries, and sustained physical/psychological stress. Examples of conditions thought to be associated with augmented pain processing include fibromyalgia, some forms of low back pain, and some forms of headache.
Approaches to Pain Management
Doctors and other professionals can use procedures, therapies, medications, and devices to help you modify how the brain processes pain; but the person with the best access to your brain is you. Thus, the best approach for managing chronic pain is a partnership between what your doctor can do and what you can do. Current approaches to chronic pain management follow a step-by-step algorithm that personalizes treatment to the type of pain you are experiencing at any given time. Below is an example of this step-by-step approach.
- Diagnosis: Chronic pain management starts with careful diagnostics of what type or types of pain you are experiencing. You can learn more about talking to your doctor about sickle cell disease and your pain symptoms.
- Education and Self Care. Self-management is the foundation of optimal pain care because it can directly impact how your brain produces the experience of pain. You can learn about self-care approaches for your pain symptoms.
- Professional Care. In addition to self-management, your doctor may want to include professional care such as medications, professional therapies, devices, and procedures. These approaches can also work to influence the perception of pain. You can learn about professional pain treatments.