Intranasal fentanyl can offer fast pain relief for adults with SCD
Study supports including intranasal fentanyl in pain protocols for adult patients
Fentanyl may be a feasible, safe, and effective option when administered intranasally (into the nose), to manage acute moderate to severe pain episodes in adults with sickle cell disease (SCD), a study in Canada reports.
For faster and non-invasive pain relief, it has been widely used in children with SCD and adults with chronic or cancer-related pain, and “extension of its use to adults with SCD appears to be a reasonable next step to address the critical need for effective and timely pain management,” researchers wrote.
The study was published as a research letter, titled “Feasibility, safety and efficacy of intranasal fentanyl in the treatment of acute pain episodes among adults with sickle cell disease: A retrospective single-centre study,” in the British Journal of Haematology.
In SCD, an abnormal form of hemoglobin, or the protein that carries oxygen in red blood cells, clumps together and causes red blood cells to acquire a sickle-like shape. These cells can become stuck inside blood vessels, blocking blood flow to different parts of the body and causing painful vaso-occlusive crises (VOCs) and other complications.
The management of acute pain episodes may be challenging, often resulting in suboptimal pain relief and reduced quality of life, particularly due to delays in accessing intravenous (into-the-vein) pain medications.
Intranasal fentanyl is a potent synthetic opioid
Intranasal fentanyl, a potent synthetic opioid, may be a non-invasive and fast-acting option for initial pain relief. In children with SCD, its use has been associated with faster pain relief and discharge from the emergency department. However, “there is currently a paucity of data to support its use in adults,” the researchers wrote.
To learn more, the Centre Hospitalier de l’Université de Montréal, a specialized care center for adults with SCD, instituted a protocol for using a single 100-microgram dose of intranasal fentanyl to manage moderate to severe acute pain episodes in outpatient care. The researchers retrospectively analyzed the treatment’s feasibility, safety, and effectiveness.
The study included a total of 23 SCD patients who were given intranasal fentanyl in 38 hospital visits. They had a median age of 26 years and were mostly women (74%). All were on disease-modifying treatments, most often hydroxyurea (87%), during the study.
Most of them (71%) received intranasal fentanyl within an hour of hospital admittance, together with nonsteroidal anti-inflammatory medications. They were subsequently given other opioids, with additional doses being administered whenever their score, assessed every 30 minutes, was above 4 on a pain scale, where 0 indicated no pain, and 10 indicated the worst imaginable pain.
The median pain score was 7, and dropped to 6 one hour after intranasal fentanyl was given, and to 3 at discharge from the hospital, which occurred at a median of four hours after the first treatment. This represented a median 60% pain reduction.
The most commonly reported side effects were nausea and itching, which required the administration of additional treatments in 18% and 10% of the visits, respectively. No serious cardiorespiratory problems or changes in mental health status were reported.
A significant proportion (43%) of participants visited outpatient care more than once, with half receiving intranasal fentanyl in subsequent visits.
“The rapid administration of [intranasal fentanyl] aligns with recommended timelines, and it was delivered without major adverse events, minimizing the need for hospital admissions or [emergency department] referrals for additional analgesia,” the researchers wrote. “We advocate for the adoption of standardized protocols incorporating [intranasal fentanyl] for adult patients.”
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