The radiofrequency therapy in management of sickle cell disease chronic pain

Abstract

Abstract Sickle cell disease causes acute and chronic pain. Pain causes significant morbidity for those living with sickle cell disease (SCD) and has a profoundly negative impact on patients' health-related quality of life (HRQOL). Pain manifests as both acute intermittent pain, chronic daily pain, and acute-on-chronic pain. The emergence of chronic pain occurs with increasing age, and it has been estimated that 30% to 40% of adolescents and adults living with SCD suffer from chronic pain. The management of acute and chronic SCD pain is a major clinical challenge. Chronic pain, in simple terms, is pain that does not go away. Some investigators define it as pain that persists for 3 or more months.Interventional pain treatments are a primary approach for chronic pain, even though their effectiveness is difficult to study. When other less invasive pain relievers don't work well enough, these techniques often provide additional relief. TECAR therapy is a unique, non-invasive treatment that uses high-frequency energy to stimulate the body's natural regenerative abilities. we investigated the effect of Transcutaneous Electrical Capacitive Resistive (TECAR) therapy on chronic pain in 170 Sickle Cell Anemia (SCA) patients using (c200 capenergy-spain )device in arandomized control trial. Inclusion criteria: 1- All types of sickle cell disease (SS/SB0/SB+/SS trait) . 2-Age of patients ranging from 6 years to 30 years. 3- SCA patients with known and unknown cause of chronic pain which is defined according to AAPT. Exclusion criteria: 1-Those patients with associated chronic disease or end organ damage. 2-patients in acute Vaso occlusive crisis. 3- Patients on antiepileptics or antidepressant drugs. All SCA patients who fulfilled inclusion criteria in absence of exclusion criteria were 190; only 170 patients agreed to consent for the study. Fifteen patients who seek frequent medical attention due to chronic pain and require analgesics on regular basis were included in the TECAR group without randomization. The rest of the studied cohort (155 patient) were randomized in a ratio of 1:1.2 to two groups , group 1(TECAR group) and group 2 (control group) .Patients in both groups received the known standard of care (SOC) in SCA (hydroxyurea, blood transfusion, regular blood exchange and analgesics). In group 1 (the TECAR group), patients received TECAR therapy in addition to SOC while group 2 (the control group) were only on SOC treatment known for SCA. The TECAR group comprised 85 sickle cell disease patients with various disease genotypes.Each patient received 2 TECAR sessions per week for 6 weeks. The standard of care known for sickle cell anemia treatment (including analgesics) was continued throughout the follow-up period.Pain-severity scores were recorded before and after each TECAR session at each visit using the VAS,BPI questionnaires.Quality of life was assessed twice using HRQol questionnaire at the start of the study and at the end of the study. The control group consisted of 85 patients with SCA, These patients received the standard pharmacological treatment for sickle cell disease, which included hydroxyurea, analgesics (either NSAIDs or paracetamol), and blood transfusions as needed. Pain scores were evaluated using the same questionnaires VAS & BPI in each visit.Quality of life was assessed using the HRQoL5D-3L questionnaire at the start and at the end of the study. The visits were 12 visits over 6 weeks follow up period. our study aim was to assess improvement of pain scores using TECAR therapy as non pharmacological modality for pain control and if this can also improve SCA patients quality of life. our results showed a statistically significant decrease in the recorded VAS score 30 min after 1st session compared to the recorded VAS score before 1st session (p value <0.001). Also, there was a statistically significant decrease in the recorded VAS scores after 30 minutes of the TECAR session in all 12 visits if compared with the recorded VAS before each session (p value<0.001 for all). There was significant improvement in HRQoL EQ VAS score also recorded (p<0.001). so we can admit that TECAR therapy can be used as anovel modality for pain control in SCA patients aiming to decrease those patients journey with pain suffering.