Morphine is an opioid narcotic available in various formulations — pill, tablet, injection, and suppository — to treat chronic and acute pain. Morphine can be used to manage moderate to severe pain in sickle cell anemia.
About sickle cell anemia
Sickle cell anemia is a heritable disease caused by mutations in the gene encoding for the hemoglobin protein, which is responsible for carrying oxygen in red blood cells. Mutations in this gene cause the red blood cells to deform or “sickle.” Sickled cells cannot easily travel through small blood vessels and are sticky because of damage to the cell’s membrane, and often block blood flow in these vessels. Such blockage leads to pain episodes known as vaso-occlusive crises.
Morphine is a narcotic that interacts predominantly with a protein receptor in the brain called the mu-opioid receptor. Morphine acts primarily in the brain, spinal cord, stomach, and intestines, causing sedation and reducing pain.
Like other opioids, morphine can be addictive, and long-term use can lower its effectiveness so that larger doses are necessary to maintain an adequate reduction in pain.
There is also some risk that morphine may exacerbate the symptoms of sickle cell anemia, though the mechanisms by which this might occur are not clear.
Morphine treatment for children with sickle cell anemia
A study published in the journal Hospital Pediatrics in 2013 examined reports of a link between morphine use and the development of acute chest syndrome in children with sickle cell anemia. Acute chest syndrome is marked by the blocking of blood vessels in the lungs, and can progress quickly without proper care. It is the leading cause of death and hospitalization in children with sickle cell anemia; about 40 percent of all acute chest syndrome episodes are reported to occur in children hospitalized for acute pain linked to a vaso-occlusive crisis.
For the study, researchers examined the hospital records of 38 children, ages 2 to 18, hospitalized for acute pain who went on to develop acute chest syndrome. They compared these data — including survival data — with that of 45 sickle cell children also hospitalized for pain but who did not develop the syndrome and were randomly selected as controls. They found that morphine use — especially with increases in cumulative dose — could be associated with an increased risk of acute chest syndrome. The scientists recommended close monitoring of children with sickle cell anemia being treated with morphine.
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