It was found to significantly reduce the rate of hospitalizations and the number of intravenous treatments patients must undergo to control these crisis.
SCD is a rare genetic disorder caused by mutations in the HBB gene, which provides instructions to make hemoglobin, a protein responsible for blood oxygen transport. In addition, in patients with SCD the red blood cells that transport oxygen have an abnormal sickle-like shape and tend to stick to each other, forming blood clots that block blood circulation. When these blockages occur and oxygen delivery is interrupted, patients may undergo VOCs, the most common painful complication of SCD. It normally requires hospitalization.
Currently, there are many treatment protocols for SCD patients experiencing VOCs. The authors of the study report that before 2013, SCD patients arriving at their emergency department with VOCs were usually put on intravenous (IV) morphine and oral ibuprofen and/or acetaminophen to control pain, along with a saline solution to remain hydrated.
However, in 2012 a group of clinicians, nurses and pharmacists interested in creating a new treatment protocol for acute pain management in SCD patients, the DrepaNoPain group, proposed “the sole use of oral morphine when possible as treatment, instead of IV opiate, hoping for faster pain relief and avoiding potentially unnecessary IV access and admission.”
The group of Canadian physicians tested whether this new treatment protocol of administering morphine orally would improve patient care and result in fewer hospitalizations.
The retrospective study reviewed the clinical records of 147 SCD patients who were admitted to the hospital emergency department or to the hematology outpatient clinic with VOCs. From these, 72 were treated with standard protocols in the year before the implementation of the new protocol, and 75 were treated with the new protocol one year after its implementation.
Results showed the new treatment protocol led to a 43% reduction in patients’ hospitalizations. In addition, after the implementation of the new protocol, there was a 35% increase in the use of oral morphine as a first-line opiate treatment, a 28% increase in the use of pain scales, and a 30% increase in the number of patients not requiring IV treatment.
“This study validates the use of our protocol promoting oral morphine for the treatment of sickle cell VOC, by showing a significant reduction in hospitalization rates. Although a reduction in time to first opiate dose was not seen in the post protocol period, it decreased the number of painful IV procedures. In order to meet quality of care indicators, new strategies will be conducted with the aim of reducing time to first opiate dose,” the scientists concluded.