Pain management in sickle cell disease: What remedy to reduce the risk of opioid abuse?

Abstract

Sickle cell disease is an inherited disorder, the hallmark of which is recurrent acute painful crises requiring opioid therapy. These acute painful episodes when superimposed on chronic pain could last for years especially in association with comorbidities like osteonecrosis, chronic leg ulcers, cholelithiasis or stuttering priapism. The need for adequate pain control in such patients should therefore be balanced to avoid opioid dependence. The treatment of superimposed acute pain with opioid in a patient with background chronic pain makes pain control a challenge. This is because the comorbidities responsible for the chronic pain are often associated with a depressive state because of limited treatment options for some of these comorbidities. Abuse of opioid by a patient with chronic pain raises the possibility of pseudoaddiction. However, abuse of opioid is not limited to patients with chronic pain or acute on chronic pain, it has also being observed in patients without chronic pain. It is necessary to decide on drugs that may adequately control chronic pain on a long term with minimal side effects; the newer drugs on the horizon which are targeted towards sickle cell disease are therefore possible viable options.

Keywords: Opioid, addiction, sickle cell pain, chronic pain, psychosocial, targeted therapy