Opioids not ideal for sickle cell patients' pain management, study says

Researchers found patients on long-term treatment plans that include opioid-based painkillers had more crisis days, greater pain and more fatigue.

By Stephen Feller

BALTIMORE, June 21 (UPI) -- Opioid painkillers are slowly being questioned as the best option for pain management as studies suggest they may prolong pain or make it worse, and a new study suggests the drugs may not be the best option for sickle cell disease patients who often experience excruciating pain.

Some sickle cell disease patients with chronic pain could be getting worse because of their treatment with opioids, researchers at Johns Hopkins University report in the American Journal of Preventive Medicine.


Sickle cell disease, which affects mostly black Americans, is a genetic blood disorder that causes hemoglobin in red blood cells to change shape, clogging up blood vessels, cutting off oxygen to the body and causing severe pain for the roughly 100,000 people in the United States who have the condition.

During episodes of clogged blood vessels, called crises, patients are often treated for pain with strong opioid painkillers. Improved treatment of the condition, however, has led to patients living longer with it, developing chronic pain conditions, which are often treated with long-term prescriptions for opioid-based drugs.

Questioning whether the long-term use of these drugs actually improved the condition of patients -- especially considering recent research in animals suggesting the drugs can make pain worse the longer they are used -- researchers involved with the recent study found those on opioids may actually be in worse condition.


"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," Dr. Pat Carroll, director of psychiatric services for the Johns Hopkins Sickle Cell Center for Adults, said in a press release. "We also need to learn more about how sickle cell disease may sensitize the nervous system."

For the new study, researchers recruited 83 people with sickle cell disease, 57 of whom were women and 26 were men, with an average age of 39. Of the patients, 29 were treated for chronic pain associated with sickle cell using long-acting opioids and 54 were not being treated with the drugs.

Filling out questionnaires between January 2010 and June 2014, the patients recorded daily pain, crises, function and any use of healthcare services for 90 days.

Overall, patients prescribed opioids for pain reported 32 percent higher levels of clinical pain, central sensitization and depression, as well as more days in crisis. Participants not on long-term opioid treatment plans had lower levels of central sensitization, and reported three times less noncrisis pain intensity than those on the drugs.


"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," Carroll said. "Too little is known about the effects of long-term opioid management of chronic pain."

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