FEATURE
“We definitely understand the need for
limitation and proper use of opioids, but
the more restrictions we put on patients
who need opioids to treat their conditions
at home, the more it has a downstream
effect of increased suffering and reliance
on the ED, when [patients] could have
potentially treated their pain at home,” Dr.
Brandow explained. “We can’t lose sight
of the fact that patients living with these
chronic conditions need pain treatment.”
The lack of alternatives to opioids also
highlights the necessity of the drugs. Ac-
cording to Dr. Brandow, there is no body
of evidence to support the use of other
medications for sickle cell pain, though, in
recent years, research has shed more light on
the pain that people with SCD experience,
with the ultimate goal of identifying “opioid-
sparing” pain-management options.
“In the past, people with SCD only
lived into their teens or early 20s,” Dr.
Clauw noted. “Now that they are living
longer, it appears that the type of pain they
experience is changing – from acute pain
to a more centralized pain.”
When sickle cell crises begin, opioids
work well to manage the acute pain, he
said. However, as with many chronic pain
conditions, the type of pain – and the
therapy needed to address it – changes over
time. “In the beginning, pain was likely due
to damage or inflammation in peripheral
tissues, but as the disease continues, pain
becomes driven by changes in the brain
and central nervous system – a type of pain
called central sensitization,” he explained.
“This type of pain is coming more from the
brain and spinal cord than the peripheral
nervous system, and opioids don’t seem to
work for that type of pain.”
When people use opioids to treat
long-term, chronic pain, they are likely to
develop tolerance to the medications.