Results of a small study of patients with sickle cell disease suggest that long-term opioid therapy may be contraindicated for treatment of their chronic pain. The study, conducted by researchers from Johns Hopkins found that patients who were prescribed long-term opioid therapy tended to score worse on measures of pain, fatigue, and activity levels than did those who were not on opioids. The team assessed 83 people with sickle cell disease, 57 women and 26 men. All were over age 18, with average age 39. 29 patients were prescribed long-term opioids and 54 were not. After 90 days, the opioid therapy cohort reported pain intensities at a level 3 times higher than the non-opioid group, as well as 2 times the level of fatigue. Study author C. Patrick Carroll, MD, director of psychiatric services for the Johns Hopkins Sickle Cell Center for Adults noted “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. Too little is known about the effects of long-term opioid management of chronic pain.” The findings were published online earlier this month in a special sickle cell disease supplement of the American Journal of Preventive Medicine.
Sickle cell disease, a genetic blood disorder affecting predominantly African Americans, causes extreme acute pain that is frequently treated with intravenous opioids medications. Adult patients with the disease frequently develop chronic pain as well, and the reasons for the progression are not well understood. As advances in treatment of sickle cell disease have led to longer patient lifespans, the incidence of chronic pain has increased, and again is often treated with long-term opioid therapy. But in addition to elevated pain and fatigue, the study cohort who received long-term opioids showed higher levels of central sensitization, which may play a role in the development of chronic pain among patients with sickle cell disorder. Read a news story about the findings here. The journal abstract may be read here.