Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic

Sinha, Cynthia; Bakshi, Nitya; Ross, Diana; Krishnamurti, Lakshmanan

doi:10.1001/jamanetworkopen.2019.4410

Cited by 66 publications

(85 citation statements)

References 39 publications

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“…19 With the recent increasing concern about opioid misuse, patients with SCD are reporting that their opioid prescriptions have become more difficult to fill and their opioid use has come under more intense scrutiny. 20 With SCD predominantly affecting blacks, the extent to which implicit bias may also play a role is unclear. 21,22 Together, these factors might present barriers to implementation of a rapid treatment guideline for opioid treatment in sickle cell patients.…”

Section: Discussionmentioning

confidence: 99%

A Multiyear Cross-sectional Study of Guideline Adherence for the Timeliness of Opioid Administration in Children With Sickle Cell Pain Crisis

Brousseau

Chamberlain

Ellison

et al. 2020

Annals of Emergency Medicine

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Study objective: The National Heart, Lung, and Blood Institute evidence-based guidelines for timeliness of opioid administration for sickle cell disease (SCD) pain crises recommend an initial opioid within 1 hour of arrival, with subsequent dosing every 30 minutes until pain is controlled. No multisite studies have evaluated guideline adherence, to our knowledge. Our objective was to determine guideline adherence across a multicenter network. Methods: We conducted a multiyear cross-sectional analysis of children with SCD who presented between January 1, 2016, and December 31, 2018, to 7 emergency departments (EDs) within the Pediatric Emergency Care Applied Research Network. Visits for uncomplicated pain crisis were included, defined with an International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 code for SCD crisis and receipt of an opioid, excluding visits with other SCD complications or temperature exceeding 38.5 C (101.3 F). Times were extracted from the electronic record. Guideline adherence was assessed across sites and calendar years. Results: A total of 4,578 visits were included. The median time to first opioid receipt was 62 minutes (interquartile range 42 to 93 minutes); between the first and second opioid receipt, 60 minutes (interquartile range 39 to 93 minutes). Overall, 48% of visits (95% confidence interval 47% to 50%) were guideline adherent for first opioid. Of 3,538 visits with a second opioid, 15% (95% confidence interval 14% to 16%) were guideline adherent. Site variation in adherence existed for time to first opioid (range 22% to 70%) and time between first and second opioid (range 2% to 36%; both P<.001). There was no change in timeliness to first dose or time between doses across years (P>.05 for both). Conclusion: Guideline adherence for timeliness of SCD treatment is poor, with half of visits adherent for time to first opioid and one seventh adherent for second dose. Dissemination and implementation research/quality improvement efforts are critical to improve care across EDs.

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Section: Discussionmentioning

confidence: 99%

A Multiyear Cross-sectional Study of Guideline Adherence for the Timeliness of Opioid Administration in Children With Sickle Cell Pain Crisis

Brousseau

Chamberlain

Ellison

et al. 2020

Annals of Emergency Medicine

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“…This ought not to be associated with the treatment of SCD patients because the report of addiction is not higher than 3%. The resultant effect of such reservation is that pain associated with VOC is often undertreated (https://www.addictioncenter.com/opiates/; https://www.emedicinehealth.com/narcotic_abuse/article_em.htm; Cynthia, Nitya, Diana, & Lakshmanan, 2019;Steven, Nahed, & Troy, 2000). Never the less, there are other drugs which are effective in the treatment of acute pains in patients.…”

Section: Media Advocacy For Special Attention To Scd Patientsmentioning

confidence: 99%

“…Physicians are encouraged to follow the three-step analgesic ladder recommended by the World Health Organization. Oral fluids and non-narcotic analgesics can be used in the treatment of patients with mild pains at home while narcotic analgesics can be used for treatments of moderate and severe pain in patients (Steven, Nahed, & Troy, 2000;Cynthia, Nitya, Diana, & Lakshmanan, 2019).…”

Section: Media Advocacy For Special Attention To Scd Patientsmentioning

confidence: 99%

“…This will enable the masses to access such treatment opportunity since a majority of citizen fall within the low-income category (Euzebus, Puline, & David, 2019;Elizabeth, Donald, Smruti, Kathleen, Mei, Daies, & Igor, 2018).The mass media should liaise with doctors in the campaign for improvement in the health sector. The aftermath of such effort can yield employment of sufficient experts hence; a multidisciplinary team made up of a physician, haematologist, nurses, psychiatrist, physical therapist, a pain specialist and a social worker could be available to attend to patients with SCD (Cynthia, Nitya, Diana, & Lakshmanan, 2019;Steven, Nahed, & Troy, 2000).…”

Section: Recommendationmentioning

confidence: 99%

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The Potential Impact of Mass Media Education in the Psycho-Social Life and Epidemiology of Sickle Cell Disease in Nigeria

Okere¹,

Morka²

2020

GJHS

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The lack of public awareness and education is the greatest challenge in the fight against Sickle Disease (SCD) in Nigeria. The sufferers of the disease experience debilitating pains, psychological challenges, stigmatization and as a result many have very poor social life style. What enduring step, has the mass media, as a reliable societal medium taken to address the spread of SCD? No serious attention has been given to the use of media technology in the education of the masses on the risk factors of SCD. The mass media has a key role to play in the treatment and management of SCD in Nigeria.

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“…In the management of cancer and sickle cell disease, multiple reports indicate that a patchwork of regulatory and coverage policies, intended to curb inappropriate opioid use, has led to significant barriers for many cancer patients when opioid use is clinically indicated for pain management. 1,2 Pain management is complex and multifactorial. Clinical practice guidelines from leading organizations play a crucial role in informing appropriate opioid prescribing practices for patients in general and for select groups with unique pain management needs.…”

mentioning

confidence: 99%

Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease

Schatz¹,

Oliver

Swarm

et al. 2020

Journal of the National Comprehensive Cancer Network

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Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and American Society of Clinical Oncology each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.

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Management of Chronic Pain in Adults Living With Sickle Cell Disease in the Era of the Opioid Epidemic

Cited by 66 publications

References 39 publications

A Multiyear Cross-sectional Study of Guideline Adherence for the Timeliness of Opioid Administration in Children With Sickle Cell Pain Crisis

A Multiyear Cross-sectional Study of Guideline Adherence for the Timeliness of Opioid Administration in Children With Sickle Cell Pain Crisis

The Potential Impact of Mass Media Education in the Psycho-Social Life and Epidemiology of Sickle Cell Disease in Nigeria

Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease

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