For the estimated 100,000 people living with sickle cell disease (SCD) in the United States, pain is a common occurrence.1,2 In addition to the acute pain resulting from vaso-occlusive crises (VOCs), many of individuals with SCD suffer from chronic pain and associated comorbidities such as depression and anxiety.2

Studies have demonstrated that more than 55% of patients with SCD experience pain on more than 50% of days, and 29% experience pain nearly every day.2 These rates are likely even higher than these findings reflect, as chronic pain in SCD is typically managed at home and thus likely underreported.

While the precise mechanisms have not been elucidated, multiple “underlying causes of pain can contribute to the evolution of chronic pain in SCD, including repeated acute nociceptive pain from VOCs, inflammatory pain, neuropathic pain, and opioid-induced hyperalgesia… all of which lead to central sensitization,” stated Osunkwo and colleagues in a 2020 review.2

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In the absence of other proven pain management strategies in SCD, opioid analgesics represent the standard treatment approach for acute and chronic pain in these patients. Nonetheless, increasing reports indicate that pain management in SCD has been complicated by efforts to stem the opioid epidemic.3

While necessary, these efforts have inadvertently “had an adverse effect by creating ‘opioidphobia’ amongst prescribers, thus denying opioids when required for sickle pain,” Kalpna Gupta, PhD, professor of medicine in the division of hematology/oncology at the University of California, Irvine, told us in an interview.4

In the context of the growing drug overdose crisis, a reliance on opioid analgesics may be conflated with drug abuse and addiction, according to Samir Ballas, MD, Emeritus Professor of medicine and pediatrics at Sydney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA. As he described in a 2016 paper, these negative and stigmatizing connotations have been unfairly applied to patients with SCD in a case of “guilt by association.”5

Across a range of studies, physicians and nurses surveyed suspected high rates of opioid abuse or addiction in patients with SCD.5 As a result, some providers have begun to “underutilize or avoid prescribing opioids to treat sickle cell pain,” Dr Ballas told us.