Pain in Sickle Cell Disease and Acute Varicella Zoster pain

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Paul Au

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Pain in Sickle Cell Disease and Acute Varicella Zoster pain – ATOTW 537

14 July 2026

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1) The pathophysiology of vaso-occlusive crises (VOCs) in sickle cell disease includes polymerization of abnormal sickle hemoglobin, inflammation, and adhesion.

True False

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VOCs pathophysiology includes polymerization of abnormal sickle hemoglobin, inflammation, and adhesion.

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2) Acute pain episodes are the most common complication of sickle cell disease.

True False

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Acute pain episodes are the most common complication of sickle cell disease.

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3) Pain in sickle cell disease is exclusively nociceptive.

True False

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Pain in sickle cell disease can be nociceptive, neuropathic, and there can be a combination of both.

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4) Priapism is a complication associated with sickle cell disease therapy.

True False

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Priapism is a complication due to the disease itself.

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5) Vaso-occlusive crises may be associated with multiple organ failure and death.

True False

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Vaso-occlusive crises may be associated with multiple organ failure and death.

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6) The treatment of acute vaso-occlusive crises in sickle cell disease is based on the use of potent opioids.

True False

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The treatment of acute crises is based on the use of potent opioids, especially morphine.

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7) Prevention of acute attacks of sickle cell disease is an effective therapy.

True False

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Prevention of acute attacks of sickle cell disease is an effective therapy and should be encouraged.

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8) The main mechanism of action of L-glutamine in the prevention of vaso-occlusive crises in sickle cell disease is the reduction of endothelial adhesion.

True False

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The main mechanism of action of L-glutamine is the reduction of endothelial adhesion.

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9) The chronic use of opioids is a common situation in patients with sickle cell disease and switching opioids is a desirable practice.

True False

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The chronic use of opioids is very common in patients with sickle cell disease and in higher-risk patients, switching opioids, such as rotation to buprenorphine, is an option to consider.

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10) There is solid evidence for the use of cannabinoids in the management of chronic pain in patients with sickle cell disease.

True False

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There are very few studies in this population and more solid information is expected so that cannabinoids can be safely indicated.

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11) Varicella Zoster Virus reactivation affects only the skin.

True False

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Varicella zoster virus reactivation affects the skin AND the nerves.

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12) Varicella zoster virus reactivation produces nerve lesions.

True False

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Varicella zoster virus reactivation produces hypoxic damage, neuronal loss in the dorsal root ganglia (DRG)

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13) Pharmacological treatment is recommended in all patients independent of the onset of the lesions in herpes zoster.

True False

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Pharmacological treatment is recommended in the first 72 hours of the onset of the lesions.

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14) Skin lessons in herpes zoster more commonly occur in bilateral dermatomes.

True False

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Generally skin lessons affect only unilateral dermatomes and can sometimes exceed the dermatomal territory.

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15) Molecular detection of varicella zoster virus DNA from skin lesions is considered the gold standard in the diagnostic of varicella zoster virus and is required for diagnosis.

True False

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The diagnosis in the majority of cases is clinical. Molecular detection of VZV DNA is the gold standard but it is rarely required.

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16) Antiviral treatment must be prescribed for 7 or 10 days in herpes zoster.

True False

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Depending on which antiviral drug is prescribed the treatment varies from 7 to 10 days.

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17) The early onset of pain makes the diagnosis of herpes zoster easy.

True False

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Herpes zoster is often misdiagnosed because the pain appears before the characteristic skin lesions.

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18) Early institution of antiviral medication does not accelerate the healing of the skin lesions in herpes zoster.

True False

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Early institution of antiviral drugs not only accelerates the healing of rash but also reduces the severity of acute pain, thus reducing the incidence of chronic pain.

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19) Pregabalin does not have any advantage compared with gabapentin to treat neuropathic pain in herpes zoster.

True False

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The positive effects of both pregabalin and gabapentin on neuropathic pain have been confirmed in trials and meta-analysis. Pregabalin has the advantage of allowing more rapid incremental dose and earlier onset of pharmacological effect.

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20) The erector spinae plane block and paravertebral block have been shown to be equivocal in herpes zoster pain relief.

True False

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An RCT has been published recently comparing paravertebral block (PVB) and erector spinae pain block (ESPB) concluding that both ESB and PVB were effective in controlling acute pain and persistent herpetic pain after 6 months, but the ESPB is safer.

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