Use of anti-inflammatory analgesics in sickle-cell disease

Han, Jin; Saraf, Santosh L.; Lash, James P.

doi:10.1111/jcpt.12592

Cited by 15 publications

(8 citation statements)

References 75 publications

(92 reference statements)

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“…Long-term use of either NSAIDs or opioids is associated with significant adverse effects. Although recurrent use of NSAIDs can lead to renal damage [3][4][5], repeated exposure to opioids is associated with dependence, development of opioid tolerance and opioid-induced hyperalgesia (OIH) [6]. Also, there is emerging epidemiological, basic science and clinical evidence that SCD-related pain has a neuropathic component because of peripheral and central nervous system abnormalities in patients with SCD [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease

Puri¹,

Morgan

Anghelescu

2019

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of reviewRecurrent exposure to opioids can lead to development of opioid tolerance and opioid-induced hyperalgesia through activation of N-methyl-D-aspartate receptors. N-methyl-D-aspartate receptor antagonists ketamine and lidocaine can modulate development of opioid tolerance and OIH. This study evaluated the utility of ketamine and/or lidocaine in decreasing opioid consumption during acute pain episodes in adolescents with sickle cell disease. There has been an increased effort to promote opioidsparing pain relieving methods given the ongoing opioid epidemic. Recent findingsThere have been six studies published over the past decade that highlight the ability of ketamine to reduce opioid consumption in the management of sickle cell disease-related pain, primarily in adult patients. There has been one study (2015) that demonstrated a similar benefit with lidocaine, however this was also in adult patients.

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Section: Introductionmentioning

confidence: 99%

Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease

Puri¹,

Morgan

Anghelescu

2019

Current Opinion in Supportive &Amp; Palliative Care

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“… 71 Non-aspirin NSAIDS – ibuprofen and ketorolac – are the most commonly encountered NSAIDs in the treatment regimen for acute SCD pain. 72 Many of the potential beneficial effects of NSAIDs are extrapolated from its use for postoperative and cancer pain. NSAIDs act on peripheral and central pain-mediated sites not involved in the opioid-mu receptor system pathways.…”

Section: Methodsmentioning

confidence: 99%

“…Understandably, given that renal disease is a common comorbidity and a complication of SCD, clinicians are reluctant to use NSAIDs regularly for SCD pain. 72 NSAIDs, however, can be an important component of a multimodal analgesia to address mild-to-moderate acute SCD pain. Short-term use (less than 5 days) in SCD patients without renal insufficiency (creatine <1.0) can be considered on an individualized basis, taking into consideration the patient’s other predisposing factors.…”

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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“…Chronic SCD pain is linked to an enormous healthcare burden, 13 and current pain treatments, which include NSAIDS 37,80 and opioids, 3 are primarily used to treat acute pain episodes and are inadequate for managing chronic pain. Furthermore, additional barriers to treatment prevent patients with SCD from receiving much needed opioid therapeutics during pain crises due to discrimination by select healthcare professionals in emergency departments.…”

Section: Possible Mechanisms Underlying Trpv4-mediated Sensitization ...mentioning

confidence: 99%

Peripheral transient receptor potential vanilloid type 4 hypersensitivity contributes to chronic sickle cell disease pain

Ehlers¹,

Sadler²,

Stucky³

2023

PAIN

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Debilitating pain affects the lives of patients with sickle cell disease (SCD). Current pain treatment for patients with SCD fail to completely resolve acute or chronic SCD pain. Previous research indicates that the cation channel transient receptor potential vanilloid type 4 (TRPV4) mediates peripheral hypersensitivity in various inflammatory and neuropathic pain conditions that may share similar pathophysiology with SCD, but this channel's role in chronic SCD pain remains unknown. Thus, the current experiments examined whether TRPV4 regulates hyperalgesia in transgenic mouse models of SCD. Acute blockade of TRPV4 alleviated evoked behavioral hypersensitivity to punctate, but not dynamic, mechanical stimuli in mice with SCD. TRPV4 blockade also reduced the mechanical sensitivity of small, but not large, dorsal root ganglia neurons from mice with SCD. Furthermore, keratinocytes from mice with SCD showed sensitized TRPV4-dependent calcium responses. These results shed new light on the role of TRPV4 in SCD chronic pain and are the first to suggest a role for epidermal keratinocytes in the heightened sensitivity observed in SCD.

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Use of anti-inflammatory analgesics in sickle-cell disease

Cited by 15 publications

References 75 publications

Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease

Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease

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

Peripheral transient receptor potential vanilloid type 4 hypersensitivity contributes to chronic sickle cell disease pain

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