Improving sickle cell pain management requires more research

Opioids aren't always effective and carry addiction risk

Oluwatosin Adesoye avatar

by Oluwatosin Adesoye |

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With sickle cell disease, pain is often ever-present. Many people who have this disease experience various forms of pain throughout their lifetimes.

Sometimes the pain is acute, other times it’s chronic, and still others it’s acute-on-chronic (when acute pain develops into chronic pain). Pain may be caused by various complications of the disease, such as leg ulcers, avascular necrosis, chronic pain syndrome, chronic fatigue syndrome, and many more. Unfortunately, this pain tends to worsen over time.

As I mentioned in my previous column, my experience with pain has evolved from acute pain crises during childhood to chronic pain, avascular necrosis, and other complications that worsen pain during adulthood.

As both a patient and a medical professional, I view the challenges of pain management from multiple perspectives. Managing chronic pain is a significant issue because it’s difficult for both patients and health professionals. The medical community continues to search for the best approaches, but hasn’t succeeded in finding them yet.

Discovering more efficacious pain medication for dangerous levels of severe pain is also problematic, because even opioids can’t tackle some levels of severe pain. They may work for only a few minutes before becoming ineffective, and the side effects can be scary.

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The Challenges of Using Opioids to Manage Crisis Pain

Opioid addiction vs. quality of life

One major issue that causes a dilemma in sickle cell pain management is the increase in the prevalence of opioid addiction. Opioids are the first line of drugs used in the management of severe pain caused by a sickle cell crisis, and addiction is one of the major side effects.

Here in Nigeria, where I live, several factors contribute to this situation, including the following:

Poor control of opioids: Opioids are controlled substances that should be dispensed only with a doctor’s prescription and administered only by qualified healthcare providers. However, in many places like Nigeria, patients often have uncontrolled access to these drugs, increasing the risk of addiction.

Self-care and home management: Due to economic challenges and difficulties accessing comprehensive healthcare facilities, patients and caregivers may indulge in self-care or home management and may administer opioids without proper medical supervision. Sometimes this involves unprofessional healthcare workers who administer medications improperly, increasing the risk of addiction or overdose.

Increase in life expectancy: In the past, sickle cell mortality was high, so the risk of addiction was lower than it is today. Unlike before, many patients now live well into adulthood, even into their 70s. The longer one is exposed to opioids, the higher the probability of becoming addicted.

Disease severity: Patients with more severe disease manifestation may require more frequent opioid use, increasing the risk of addiction.

Poor pain management by healthcare providers: The frequent undermanagement of pain by healthcare professionals during patient hospitalizations may prompt these patients to seek alternative measures like self-management, which can increase addiction risk.

During one of my clinical presentations on sickle cell pain management, several questions arose regarding the challenge of balancing opioid addiction prevention with the patients’ right to access effective pain relief. This is because the repercussions of opioid addiction extend beyond physical health, potentially leading to financial and psychological distress, respiratory depression, and even fatal overdose.

Reducing opioid addiction without compromising patients’ access to pain management remains a pressing dilemma in medicine. I’ve heard it suggested that healthcare providers should undermanage pain or advocate for patients to tolerate more discomfort. But I believe the most effective solution would be to research and develop new, nonaddictive medications that provide an equal or greater level of severe pain relief as opioids.

Given that we currently lack effective alternatives, it feels profoundly unjust to ask sickle cell warriors to endure excruciating pain as a way of life. Living in constant pain can render life meaningless, pushing individuals toward despair and suicidal ideation. It’s unfair.

In the meantime, we must weigh the benefits and risks of opioid use for pain management, particularly for those at a high risk of opioid addiction. Warriors should do their utmost to avoid controllable risk factors, such as by refraining from self-medicating with injectable drugs at home and obtaining opioids illegally, and by always seeking professional medical assistance for serious health concerns.

For uncontrollable factors, like disease severity, exploring alternative pain management strategies is crucial, even if they may not be as effective. Engaging in distractions can help, and enduring mild or moderate pain is advisable only if possible.

For those already grappling with addiction, it’s important not to assume you can handle it alone. Seek help, as it’s crucial to have a multidisciplinary team that includes a hematologist and a psychiatrist. Addiction treatment can be challenging, so if you find yourself relapsing, remember that there is no shame in returning for treatment.

For family and friends of those battling addiction to pain medication, please approach the situation with empathy rather than judgment. Addiction is a mental health issue. Supporting your loved one in seeking professional help is the best way to assist them.


Note: Sickle Cell Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Sickle Cell Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to sickle cell disease.

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