For patients suffering from sickle cell disease, pain can be a daily struggle. Life-saving work at the Blood Research Institute is improving patient outlooks and quality of life.
Joshua Field, M.D., of the Blood Research Institute (BRI) has made it his life’s mission to better the lives of patients suffering from sickle cell disease (SCD), in which red blood cells are bent, or shaped like a sickle. This impacts the blood’s ability to flow throughout the body, causing chronic pain.
It’s estimated that 1 in 400 African Americans in the United States is affected by sickle cell disease. In a recent study, “Dyspareunia is associated with chronic pain in premenopausal women with sickle cell disease,” a team of investigators, including Dr. Field, surveyed premenopausal women with sickle cell disease to determine whether chronic pain associated with the disease is also associated with an increased prevalence of dyspareunia (or pain during sexual intercourse). The team found that dyspareunia is common in women with sickle cell disease, and even more common for women with sickle cell disease who also report chronic pain.
But Dr. Field’s research goes even further than that. He first became interested in sickle cell disease during his training at Washington University in St. Louis, where he worked with foremost expert Michael DeBaun, M.D. Together, Drs. Field and DeBaun collaborated with University of Virginia investigators, whose expertise in interstitial lung disease (or lung scarring) coincided with Dr. DeBaun’s interest in lung complications related to sickle cell disease.
What these investigators found was that fibrocytes, or cells in the blood that are associated with conditions like lung scarring and tumors, were increased in sickle cell disease patients. And in 2017, a study demonstrated that in sickle cell disease patients, the fibrocytes were associated with poor pulmonary function. That suggests that these fibrocytes are a biomarker in sickle cell patients, which means they can be used to identify patients who are likely to develop lung complications related to their disease.
According to Dr. Field, it’s estimated that as many as 30% of sickle cell disease patients die as a result of lung complications. So, what next? Field and his team at the Blood Research Institute are contributing to new therapies and treatments surrounding sickle cell disease and pulmonary function. The better these investigators are able to understand which patients are most likely to develop lung complications, the easier it will be to discover new treatments and cures.
But what about patients who already suffer from the effects of sickle cell disease? The newborn screening program at Children’s Hospital of Wisconsin receives funding from the state to examine and treat babies, and Dr. Field’s Adult Sickle Cell Clinic at Froedtert Hospital—the only one of its kind in Wisconsin—provides care for 425 adults with sickle cell disease. Many of these patients receive regular blood transfusions, which are used as both a treatment and preventative measure.
Currently, the only cure for sickle cell disease is a bone marrow transplant, which has been an option for very few adults, who are often too sick. Younger patients are generally considered better candidates; however, the procedure is still risky, and acute care (like regular blood transfusions) can prolong the patient’s lifespan.
That means pain management is of utmost importance, Dr. Field says, especially for the 50% of adults with sickle cell disease who report having chronic pain. Historically, the go-to pain management tool has been opioids, but many physicians are trying to move away from or limit the use of those drugs. The problem, however, is that opioids work. This is a particular area of interest for Dr. Field, who says that the human brain is rewired, in a manner of speaking, in people with chronic pain. Is there a way to uncross those wires? What cures or therapies might help these patients? This is something the investigators at the Blood Research Institute are researching.
About the expert: Joshua Field, M.D., is a medical director at BloodCenter of Wisconsin, investigator at the Blood Research Institute and associate professor of medicine within the division of Hematology/Oncology at the Medical College of Wisconsin (MCW). Learn more about Dr. Field.