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Medical Rounds

Sickle Cell and Opioids

Adults with sickle cell disease often experience excruciating chronic pain, prompting physicians to treat them long term with opioid medications.

But a new Johns Hopkins study looking at pain assessments in such patients questions this practice. The study found that adult patients with sickle cell who were treated long term with opioids often fared worse in measures of pain, fatigue and curtailed daily activities than those not on long-term opioids.

“We need to be careful and skeptical about giving increasing doses of opioids to patients with sickle cell disease who are in chronic pain if it isn’t effective,” says study leader C. Patrick Carroll, director of psychiatric services for the Johns Hopkins Sickle Cell Center for Adults. “Too little is known about the effects of long-term opioid management of chronic pain.”

Because advances in treatment of sickle cell disease have led to many more people living well into adulthood, chronic pain has been a growing problem for people with the disorder. These patients are also often treated with opioid pain medications for this chronic pain.

But animal research and some human studies suggest that opioids can paradoxically increase pain sensitivity. This concern, combined with rising awareness of the dangers of opioid therapy, particularly at high doses, has led to a re-evaluation of long-term opioid therapy for many conditions. However, those patients with sickle cell disease who have chronic pain often are prescribed high doses of opioids because the disorder is so hard to treat and recurrent crises can lead to escalating doses.

Carroll, whose study included 83 adults with sickle cell disease, cautions that his team’s work is preliminary and should not lead physicians or people with sickle cell disease to take away opioids that many need to control unbearable pain. One of the biggest challenges in sickle cell disease is that clinicians may not believe patients are in pain when there aren’t any signs of tissue damage or believe they are drug-seeking, and thus contribute to suffering.

“We need to better understand how long-term opioid use affects pain sensitization and determine if certain people are more sensitive to these effects so we can prescribe the best treatment option for each individual patient,” says Carroll. “We also need to learn more about how sickle cell disease may sensitize the nervous system.”

The study was published online on June 15 in a special sickle cell disease supplement of the American Journal of Preventive Medicine.