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Chronic opioid therapy is more strongly associated with central sensitization in sickle cell disease than clinical pain

key information

source: The Journal of Pain

year: 2015

authors: P. Carroll, C. Campbell, G. Moscou-Jackson, P. Finan, S. Lanzkron, C. Haywood Jr., J. Haythornthwaite

summary/abstract:

Central nervous system sensitization (CS) is common to a number of chronic pain conditions. Adult patients with sickle cell disease (SCD) often have chronic pain. Both animal and human evidence suggests that central sensitization is a factor in its development or maintenance. Patients with SCD are often treated with opioids, which can produce paradoxical pain facilitation through central mechanisms. This analysis examined the relationship of chronic opioid therapy (COT, those prescribed daily long-acting opioids) to central sensitization with SCD. Using baseline quantitative sensory testing, we identified a subgroup of participants with SCD showing a pattern of CS (n=21) and a group showing no or low CS (n=17) using norms derived from healthy controls.

High CS participants reported greater baseline pain (Brief Pain Inventory Severity mean = 3.55 vs. 0.54, p<<0.001). Demographics (sex, age, and education) and measures of SCD severity were entered into a multivariable model predicting central sensitization along with COT. After backward stepwise model simplification, baseline pain dropped out of the model and chronic opioid therapy was the strongest individual baseline predictor of CS (OR=1.53, 95% CI = 1.14, 2.05). In prospective daily diary measures following baseline assessment, average daily pain and pain catastrophizing were associated with CS. Entering chronic opioid therapy into these models reduced the predictive power of average daily pain below statistical significance, though daily catastrophizing remained an independent predictor of CS.

The CS group had a higher proportion of participants on chronic opioid therapy (61.9%) relative to the no/low CS group (13.3%) and this association was stronger than, and statistically independent from, baseline pain. The results raise the possibility that opioid-induced hyperalgesia may contribute to chronic pain via central sensitization in SCD. Prospective studies of central sensitization and pain outcomes from chronic opioid therapy in SCD are warranted. Supported by grant NIH/NHLBI 5R01HL098110.

organization: Johns Hopkins University School of Medicine, Baltimore, MD

DOI: 10.1016/j.jpain.2015.01.149

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