Efficacy and Tolerance of Lidocaine 5% Patches in Neuropathic Pain and Pain Related to Vaso-occlusive Sickle Cell Crises in Children: A Prospective Multicenter Clinical Study

The majority of hospitalizations of patients with sickle cell disease (SCD) are related to painful vaso-occlusive crises (VOCs). Although the pain of VOC is classically nociceptive, neuropathic pain (NP) has also been demonstrated in SCD patients. The aim of our study is to specify the prevalence of NP during VOCs in SCD children using a dedicated scale and to measure its characteristics. We performed a prospective study that included SCD children hospitalized for an acute VOC. The presence of NP was sought with the DN4 scale on the second and fourth days of hospitalization. A total of 54 SCD children were included in the study. Overall, 41% of the patients (n = 22) experienced neuropathic pain during the VOC, mostly at an early stage (Day 2). The median age, the sex ratio, the location of the pain, and the morphine consumption were similar for patients with and without NP. Our study shows that neuropathic pain is very common during VOCs in SCD children. The absence of identified risk factors should prompt us to be vigilant regardless of the patient’s age, sex, and clinical presentation.

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Immediate Loading of Single Post-Extractive Implants in the Anterior Maxilla: 12-Month Results From a Multicenter Clinical Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-11-00058 ◽

2012 ◽

Vol 38 (S1) ◽

pp. 477-484 ◽

Cited By ~ 4

Author(s):

Tommaso Grandi ◽

Giovanna Garuti ◽

Rawad Samarani ◽

Paolo Guazzi ◽

Andrea Forabosco

Keyword(s):

Clinical Study ◽

Soft Tissue ◽

Bone Resorption ◽

Tooth Extraction ◽

Immediate Loading ◽

Insertion Torque ◽

Anterior Maxilla ◽

Implant Placement ◽

Implant Size ◽

Multicenter Clinical Study

The purpose of the study was to evaluate survival and peri-implant bone levels of single, immediately loaded post-extractive implants in the anterior maxilla 12 months after implant placement. Thirty-six consecutive patients from 3 study centers were included in the study. The concerned sites were upper premolars, canines, and incisors. For each patient the following data were recorded: reason for tooth extraction, bone quality, implant size, and final insertion torque. Implants were placed using a flapless technique and immediately loaded with a nonoccluding temporary restoration. Final restorations were provided 4 months later. Peri-implant bone resorption was evaluated radiographically after 6 and 12 months. The average final insertion torque was 70.55 Ncm. One implant inserted in D3 quality bone with a 35-Ncm seating torque was lost. All other implants had a final insertion torque ranging between 50 and 80 Ncm. The average peri-implant bone loss was 0.437 and 0.507 mm at 6 and 12 months, respectively. All the sites maintained excellent papillae and peri-implant soft-tissue conditions. The resulting 1-year success rate was 97.2%. Immediate nonfunctional loading of single post-extractive implants in the anterior maxilla is a predictable treatment. And it seems that achieving high insertion torques by placing self-tapping/self-condensing implants in an underprepared osteotomy is favorable.

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Nonfunctioning pancreatic endocrine tumors: a multicenter clinical study

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2003.07704.x ◽

2003 ◽

Vol 98 (11) ◽

pp. 2435-2439 ◽

Cited By ~ 101

Author(s):

Lucio Gullo ◽

Marina Migliori ◽

Massimo Falconi ◽

Paolo Pederzoli ◽

Rossella Bettini ◽

...

Keyword(s):

Clinical Study ◽

Endocrine Tumors ◽

Pancreatic Endocrine Tumors ◽

Multicenter Clinical Study

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Increased Urinary Porphyrin Excretion in Sickle Cell Crises

Experimental Biology and Medicine ◽

10.3181/00379727-123-31387 ◽

1966 ◽

Vol 123 (1) ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

H. N. Naumann ◽

L. W. Diggs ◽

F. S. Schlenker ◽

L. Barreras

Keyword(s):

Sickle Cell ◽

Sickle Cell Crises

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Sickle cell pain: a critical reappraisal

Blood ◽

10.1182/blood-2012-04-383430 ◽

2012 ◽

Vol 120 (18) ◽

pp. 3647-3656 ◽

Cited By ~ 221

Author(s):

Samir K. Ballas ◽

Kalpna Gupta ◽

Patricia Adams-Graves

Keyword(s):

Chronic Pain ◽

Neuropathic Pain ◽

Sickle Cell ◽

Multiorgan Failure ◽

Organ Damage ◽

Acute Chest Syndrome ◽

Prodromal Phase ◽

Pain Syndromes ◽

Painful Episode ◽

Chronic Pain Syndromes

AbstractSickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute painful episode at the prodromal phase could potentially prevent or minimize tissue damage. Our hypothesis is that managing these events with hydration, anti-inflammatory drugs, aggressive analgesia, and possibly vasodilators could abort the crisis and prevent or minimize further damage. Chronic pain syndromes are associated with or accompany avascular necrosis and leg ulcers. Neuropathic pain is not well studied in patients with sickle cell disease but has been modeled in the transgenic sickle mouse. Management of sickle cell pain should be based on its own pathophysiologic mechanisms rather than borrowing guidelines from other nonsickle pain syndromes.

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