Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults

Cooper, Tess E; Hambleton, Ian; Ballas, Samir K.; Wiffen, Philip J

doi:10.1002/14651858.cd012187.pub2

Cited by 15 publications

(17 citation statements)

References 84 publications

(2 reference statements)

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“…Several systematic reviews have been published over the past years in the field of SCD to assess analgesic intervention [26][27][28] or transfusion therapy efficacy 29 in the setting of VOC or ACS. Two recent studies reported a descriptive review, assessing available evidence in favor and against the use of corticosteroids therapy, but without meta-analysis 30,31…”

Section: Discussionmentioning

confidence: 99%

Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis

et al. 2022

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Whether corticosteroids improve outcome in patients with acute complications of sickle cell disease (SCD) is still debated. We performed a systematic review of the literature with the aim of estimating effects of corticosteroids on the clinical course of vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) in patients with SCD. The primary outcome was transfusion requirement during hospitalization. Studies were identified by search of MEDLINE and CENTRAL database. Three randomized clinical trials (RCT) and three retrospective cohort studies (RCS) were included, involving 3,304 participants and 5,562 VOC or ACS episodes. There was no difference between corticosteroids and standard treatment regarding transfusion overall [OR=0.98 (95% CI 0.38 to 2.53)], but with a significant interaction of study type (P

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Section: Discussionmentioning

confidence: 99%

Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis

et al. 2022

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“…We limited our search to non-opioid analgesics that have established use in other painful conditions and are accessible and used with some frequency within SCD clinical practice. 27 , 60 , 61 Although non-pharmacological interventions are an important component of multimodal pain management, such interventions were not included in our literature search for the following reasons: 1) these interventions are usually inaccessible in the acute clinical setting for management of acute SCD pain, 2) sickle cell providers lack familiarity with these interventions, and 3) the evidence for these interventions for acute SCD pain is sparse. 27 , 60 , 62 , 63 In addition, because this review is focused on acute SCD pain, non-opioid adjuncts, such as antidepressants, which may be used in the outpatient setting for chronic SCD pain 61 were not included in our literature search.…”

Section: Methodsmentioning

confidence: 99%

“… 27 , 60 , 61 Although non-pharmacological interventions are an important component of multimodal pain management, such interventions were not included in our literature search for the following reasons: 1) these interventions are usually inaccessible in the acute clinical setting for management of acute SCD pain, 2) sickle cell providers lack familiarity with these interventions, and 3) the evidence for these interventions for acute SCD pain is sparse. 27 , 60 , 62 , 63 In addition, because this review is focused on acute SCD pain, non-opioid adjuncts, such as antidepressants, which may be used in the outpatient setting for chronic SCD pain 61 were not included in our literature search. Based on these considerations, our list of non-opioid analgesic adjuncts was narrowed to intravenous acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), ketamine, anticonvulsants (gabapentin and pregabalin) and lidocaine.…”

Section: Methodsmentioning

confidence: 99%

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review

Kenney¹,

Smith²

2022

JPR

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Purpose of Review Sickle cell disease (SCD) is an inherited hemoglobinopathy with potential life-threatening complications that affect millions of people worldwide. Severe and disabling acute pain, referred to as a vaso-occlusive crisis (VOC), is a fundamental symptom of the disease and the primary driver for acute care visits and hospitalizations. Despite the publication of guidelines for VOC management over the past decade, management of VOCs remains unsatisfactory for patients and providers. Recent Findings Acute SCD pain includes pain secondary to VOCs and other forms of acute pain. Distinguishing VOC from non-VOC pain may be challenging for both patients and clinicians. Further, although opioids have been the gold-standard for VOC pain management for decades, the current highest standard of care for all acute pain is a multimodal approach that is less dependent on opioids, and, instead incorporates analgesics and adjuvants from different mechanistic pathways. In this narrative review, we focus on a multimodal pharmacologic approach for acute SCD pain management and explore the evidence for existing non-opioid pharmacological adjuncts. Moreover, we present an explanatory model of pain, which is not only novel in its application to SCD pain but also captures the multidimensional nature of the SCD pain experience and supports the need for such a multimodal approach. This model also highlights opportunities for new investigative and therapeutic targets – both pharmacological and non-pharmacological. Summary Multimodal pain regimens that are less dependent on opioids are urgently needed to improve acute pain outcomes for individuals with SCD. The proposed explanatory model for SCD pain offers novel opportunities to improve acute pain management for SCD patients.

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“…El manejo de las crisis vasooclusivas dolorosas incluye intervenciones farmacológicas como opioides, analgésicos no opioides, medicamentos en combinación, oxigenación e hidratación (41). Las intervenciones no farmacológicas, como el entrenamiento físico de resistencia, han mostrado efectos benéficos en la red capilar muscular de pacientes con anemia de células falciformes, por lo que teóricamente podría aportar al manejo y prevención de estas crisis (42).…”

Section: Tratamientounclassified

Anemia falciforme y la resistencia a la malaria. Revisión narrativa

Isaza

Herrera-Almanza

Hernández-Martínez

et al. 2020

Rev. Fac. Cienc. Salud Univ. Cauca

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La enfermedad de células falciformes (SCD, por sus siglas en inglés) es una hemoglobinopatía autosómica recesiva, producida por la mutación del gen de la cadena β-globina que genera la sustitución de valina por el ácido glutámico en la posición del sexto aminoácido de la hemoglobina. Existen diversos mecanismos moleculares y celulares por los cuales se explica su fisiopatología y gracias a su actual entendimiento, se encuentran en investigación clínica y preclínica nuevos agentes farmacológicos. La hemoglobina falciforme (HbS), que es la consecuencia de dicha mutación, se relaciona como una forma de protección contra la malaria en los heterocigotos; sin embargo, el estado homocigoto (HbSS) puede estar asociado con una mayor susceptibilidad a la malaria. Dicha relación de protección en heterocigotos se evidencia en niveles más bajos de parasitemia y de aparición más tardía, lo que se ha tratado de explicar por diversas teorías. Por tanto, este artículo tiene como objetivo revisar la relación entre la SCD y la protección que genera en infección por malaria, además de exponer la fisiopatología y el tratamiento de la SCD para lograr un entendimiento más amplio de la enfermedad.

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Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults

Cited by 15 publications

References 84 publications

Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis

Effects of corticosteroids in patients with sickle cell disease and acute complications: a systematic review and meta-analysis

Moving Toward a Multimodal Analgesic Regimen for Acute Sickle Cell Pain with Non-Opioid Analgesic Adjuncts: A Narrative Review

Anemia falciforme y la resistencia a la malaria. Revisión narrativa

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