Sickle Cell Pain: Call for Whole Person Health Approaches to Mechanisms-informed Integrative Management

Ms. Edwards is a 21-year-old woman with sickle cell disease (SCD, S + genotype) who experienced 38 acute healthcare utilization events during the past year, resulting in 185 hospital days.Her case (Table 1) illustrates the urgent need for an integrative, whole person health (IWPH) approach to mechanism-based pain management in sickle cell disease (SCD) to maximize analgesia, minimize side effects, and support self-management. 1,2in in SCD is complex, neural signals modulated from the peripheral nociceptor through the spinal cord to brain centers where pain is perceived.Modulation can inhibit or facilitate pain, and therapies that mimic or enhance inhibitory mechanisms include diseasemodifying, opioid, non-opioid, and non-pharmacologic interventions used in combination.An IWPH perspective deliberately integrates biomedical, behavioral, and complementary strategies based on pain mechanisms (Table 2), with the goal of translating mechanismbased, patient-centered interventions into clinical care for individuals with SCD.Used systematically based on pain mechanisms, the IWPH perspective inherently combines biomedical, behavioral, and complementary strategies to address the full spectrum of a person's pain experience.In this commentary we provide rationale and ideas for translating mechanism-based, patient-centered interventions for individuals with SCD.