Opioid Use in Adults With Sickle Cell Disease Hospitalized During Vaso-Occlusive Crisis: A Systematic Review

Applying Comfort Theory to Improve Outcomes for People in Sickle Cell Crisis

“…This leads to emergency room visits (Barriteau et al, 2019) and frequent hospitalization for pain management, oxygenation, and red blood cell replacement (Borhade & Kondamudi, 2022; Uwaezuoke et al, 2018). While non-opioid medications can be adjunctive for VOC, and other medications are being explored, opioid use remains the mainstay for treatment (Osborne et al, 2021). Complications of opioid use include constipation, nausea, and drowsiness.…”

“…This is especially true for people without private health insurance (Power-Hays & McGann, 2020). VOC patients may feel mistreated by healthcare professionals who imply that pain levels are being exaggerated or that people in VOC are seeking opioids for addiction (Blake et al, 2018; Brandow et al, 2020; Lattimer et al, 2010; Osborne et al, 2021). This issue can cause patients to feel unable to express their needs, second-guess their sense of self and self-efficacy, and develop mistrust and anger toward the healthcare team (Blake et al, 2018; Lattimer et al, 2010; Osborne et al, 2021).…”

“…Chronic use increases the risks for tolerance, physical dependence, abuse, and addiction. Due to changes in prescribing due to the US opioid misuse epidemic, pain management for people with SCD has grown more complicated (Osborne et al, 2021).…”

Opioid Use in Patients With Sickle Cell Disease During a Vaso-Occlusive Crisis: A Systematic Review

“…Moreover, there were no consistent data exists to address the type, method, and amount of opioid administration in hospitalized sickle cell patients during VOC with the need to implement multi-modal evidence-based strategies as well as educate health care personnel in the management of VOC and the resulting SCD pain [ 11 ]. For these reasons, many factors have been identified to influence patient care and are associated with suboptimal analgesia and have been described as barriers to adequate care for patients during ED visits, including health care providers' fear of possible drug-seeking behaviors as well as frequent ED visits for pain management [ 27 ].…”

“…Moreover, healthcare providers are not adequately informed on how variable and intense these painful VOC can be and what should be initially done for managing them as they often view SCD patients as "opioid medication/drug seekers" due to the stigma associated with the need to control their pain with potent opioids and concerns regarding addiction [ 11 ]. Overall, considering suboptimal pain management of VOC in SCD patients can lead to the development of opioid tolerance as well as chronic pain with the possibility of developing neuropathic pain and a chronic need for narcotic medications [ 12 ].…”