Association of depression and hydroxyurea use with neuropathic pain in hemoglobinopathies

This study aimed to investigate the presence of neuropathic pain and its associated factors in patients diagnosed with the hemoglobinopathies thalassemia major (TM) and sickle cell disease (SCD). This study included 27 patients with TM and 30 patients with SCD who presented to the neurology clinic between 2022 and 2023. All participants had normal electromyography (EMG) findings and nerve conduction studies. Patients aged between 20 and 50 years were evaluated for neuropathic pain using the Neuropathic Pain Scale (DNET-4). Data were analyzed in relation to age, sex, smoking status, hemoglobin levels, platelet count, ferritin levels, presence of depression, use of hydroxyurea and chelation therapy, and splenectomy status. Depression was assessed using the Beck Depression Inventory. Patients with neuropathy due to anatomical pathology, lumbar disc herniation, diabetes mellitus, prior use of neurotoxic drugs, or clinical signs of peripheral nerve involvement were excluded from the study. The mean age was 29.22 years in the TM group and 32.03 years in the SCD group (p = 0.010). Neuropathic pain was reported by 37.1% of patients with TM and 46.7% of those with SCD, with higher pain scores tending to occur in the sickle cell group (p = 0.069). A statistically significant difference and moderate positive correlation were found between neuropathic pain and hydroxyurea treatment (p < 0.01). No significant difference was observed between the groups in terms of depression levels (p = 0.63); however, a strong positive correlation was found between depression severity and neuropathic pain scores (p < 0.001). As depression levels increased, neuropathic pain severity also increased. The TM group had significantly lower hemoglobin levels (8.21 ± 0.92 g/dL) compared to the SCD group (10.03 ± 1.45 g/dL) (p < 0.001). Ferritin levels were significantly higher in the TM group (2678 ± 1689 ng/mL) than in the sickle cell group (580 ± 689 ng/mL) (p < 0.001). No statistically significant associations were observed between neuropathic pain and chelation therapy, splenectomy, or smoking status. Neuropathic pain in patients with TM and SCD was significantly associated with depression severity. Hydroxyurea treatment showed a moderate association with neuropathic pain in patients with SCD, potentially reflecting greater disease burden. These findings underscored the importance of comprehensive clinical evaluation, including both neurological and psychological assessments, in the management of these patients.