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Opioid Backlash Threatens Sickle Cell Care

Opioid Backlash Threatens Sickle Cell Care

The well-meaning push to curb opioid prescribing could worsen healthcare for sickle cell patients. Clinicians tend to undertreat the substantial pain experienced by many sickle cell patients and treat them as drug addicts. However, research does not support increased risk of addiction in this patient population. Challenging Pain, Few Options A 2008 study in Annals of Internal Medicine revealed a vast undercurrent of chronic pain in sickle cell disease, with 29% of patients reporting pain—which is often severe—nearly every day. On top of that, vaso-occlusive episodes can trigger excruciating pain and life-threatening complications, such as organ damage. These crises prompt most ED visits for sickle cell disease. Hydroxyurea, the one drug approved by the FDA to treat the disease, is used infrequently despite being effective. The drug lessens the frequency of pain crises but does not eliminate them. In any case, opioids remain essential for treating sickle cell pain. Clinical trials testing these agents in sickle cell populations are lacking, but even less is known about possible alternatives. Inaccurate Assumptions of Pain A recent study found that most sickle cell patients delay seeking treatment until their pain nears 9 on a 10-point intensity scale. When they finally go to the ED, they face longer waits for care than others in less pain. In some research, these patients report that healthcare providers sometimes treat them without respect. Indeed, clinicians often wrongly suspect them of exaggerating their pain or abusing drugs. A Patient-Centered Approach to Treating Sickle Cell Pain Treating sickle cell pain starts with assessment, but no laboratory test or physiological marker can measure this pain. Nor can clinicians gauge...
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