Background: Pain is a common, debilitating, and poorly understood complication of sickle cell disease. The need for clinical pain management of sickle cell disease is largely unmet and relies on opioids as the main therapeutic option, which leads to a decreased quality of life (QoL). According to the literature, acupuncture has shown certain therapeutic effects for pain management in sickle cell disease. However, these clinical studies lack the guidance of Traditional Chinese Medicine (TCM) Syndrome Differentiation principles for treatment.
Aim: To characterise differences in clinical presentation amongst TCM-diagnosed syndromes in sickle cell disease patients.
Method: 52 patients with sickle cell disease and 28 age- and sex-matched healthy controls were enrolled in an ongoing trial of acupuncture. Each participant completed a series of questionnaires on pain, physical function, fatigue, sleep, anxiety, depression, and QoL and underwent cold- and pressure-based quantitative sensory testing at baseline. Data on prescription opioid use over the 12 months prior to study enrollment was used to calculate mean daily morphine milligram equivalents (MME). Differences among the three TCM syndromes were analyzed by one-way ANOVA followed by Tukey post hoc testing. Two-sample t-tests were used to compare sickle cell disease and healthy control groups.
Results: TCM diagnosis criteria classified sickle cell disease patients into one of three TCM syndromes: a) Equal; b) Deficiency; and c) Stagnation. The Stagnation group exhibited higher pain interference, physical dysfunction, nociplastic pain, fatigue, anxiety, depression, MME consumption, and lower sleep quality and QoL compared to the Equal group. Few differences were observed between healthy control and the Equal sickle cell disease group across outcomes. Deficiency and Stagnation groups were differentiated with observed- and patient-reported clinical manifestations.
Conclusion: These findings suggest that TCM-diagnosed syndromes in sickle cell disease can be differentially characterized using validated objective and patient-reported outcomes. Because characteristics of pain and co-morbidities in each sickle cell disease patient are unique, targeting specific TCM “syndromes” may facilitate treatment effectiveness with a syndrome-based personalized treatment plan that conforms to TCM principles. These findings lay the foundation for the development of tailored acupuncture interventions based on TCM syndromes for managing pain in sickle cell disease. Larger samples are required to further refine and validate TCM diagnostic criteria for sickle cell disease.