Sickle cell anemia patients frequently experience different types of pain.

Acute pain is often caused by a vaso-occlusive crisis (VOC), which occurs when sickle-shaped red blood cells aggregate and block small blood vessels. VOC should be treated as a medical emergency because the pain can be severe.

Sickle cell patients can also experience chronic pain, the cause of which is not entirely understood. It is thought that recurrent painful episodes and inflammation can lead to chronic pain.

Moderate and severe pain in sickle cell anemia can often be managed with opioid narcotics, or opioids.

What are opioids?

Opioids are substances that relieve pain. They are used for managing many different kinds of pain. They act by binding to opioid receptors that are located on the surface of nerve cells and inhibit the transmission of pain signals. Because opioids suppress nerve signals in the brain and spinal cord, they often cause drowsiness and sedation.

Opioids for pain in sickle cell anemia

In patients with sickle cell anemia, opioids can be used to treat both acute and chronic pain.

Acute moderate pain is usually managed with a weak opioid such as codeine or oxycodone in combination with a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen, ketorolac, and diclofenac that are commonly used in sickle cell anemia patients.

Stronger opioids are often needed for the management of severe acute pain. In such cases, morphine or equivalent opioids such as levorphanol, methadone, oxymorphone, or fentanyl may be used.

Opioids are also used for the management of long-term chronic pain. However, frequent use of opioids may require the escalation of doses, and there is some evidence that opioids can, paradoxically, increase patients’ sensitivity to pain.

Sickle cell anemia patients who are treated long-term with opioids may actually do worse regarding pain, fatigue, and the management of daily activities than those who are not treated with long-term opioid treatment.

Risks associated with opioids

Physicians are often cautious about prescribing opioids because they fear opioid addiction. The problem is that pain is very subjective and generally not measurable, and clinicians can only rely on patients’ own statements about their pain. Pain management guidelines are aimed at improving the situation.

In response to increasing opioid addiction and the so-called opioid crisis in the U.S., the Food and Drug Administration aims to restrict opioid access. The goal is to avoid misuse and abuse of opioids while simultaneously allowing access for those who need them to manage pain.

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