sickle cell disease is a rare blood disorder that causes excruciating pain. It is a genetic disease that affects predominantly African Americans in the US, and is caused by a mutation in the gene that produces hemoglobin -. The protein that carries oxygen that gives the red pigment in red blood cells
Long Term Opioids may not be the best option for pain management sickle cell patients
In cells with the mutation, hemoglobin forms long chains that make the normally round and fleshy red blood cells take on a sickle shape and clog blood vessels. The covered containers can cut off oxygen to tissues and cause bouts of intense pain known as crises. The pain of these episodes often leads to people with the disease to emergency rooms, where they are treated aggressively for pain – usually with intravenous opioid analgesics.
‘sickle cell anemia patients treated long-term opioid often fared worse on measures of pain, fatigue and reduced and daily activities of opioids not in the long term. “
Often, adult patients with sickle cell disease also develop chronic pain, and how it manifests is little known. Due to advances in the treatment of sickle cell disease have resulted in many more people living in adulthood, chronic pain has been increasing for people with this disorder problem. These patients are also often treated with opioid analgesics for chronic pain. However, there is no good evidence that long-term therapy is effective opioid.
Animal research and some human studies suggest that opioids may increase, paradoxically, sensitivity to pain. This concern, coupled with the growing awareness of the dangers of opioid therapy, especially at high doses, has led to a reassessment of opioid therapy long term for many conditions. However, those patients with sickle cell disease who have chronic pain often high doses of opioids are prescribed because the disorder is so difficult to treat and recurrent crises can result in increasing doses.
In a small study analyzing assessments pain in adults with sickle cell disease, researchers at Johns Hopkins says in general, patients receiving long-term opioid often fared worse on measures of pain, fatigue and reduced daily activities than those without long-term opioids.
In a report on the new research, published online in a special supplement of sickle cells American Journal of Preventive Medicine C. Patrick Carroll, and colleagues evaluated experiences pain participants sickle cell who were prescribed long-term opioid disease.
“We have to be careful and skeptical about giving increasing doses of opioids for patients with sickle cell disease who are in chronic pain if not effective disease,” says Carroll, director of psychiatric services for the Center for Sickle Cell Johns Hopkins for adults and assistant professor of psychiatry and behavioral sciences at the Faculty of Medicine at Johns Hopkins University. “Very little is known about the effects of opioid administration’s long-term chronic pain.”
For the new study, researchers at Johns Hopkins recruited 83 people with sickle cell disease – 57 women and 26 men – over 18 years, with an average age of 39. Doctors examined the medical records of the patient to determine who was taking long-term opioid. 29 patients were prescribed daily, long-acting opioids to control pain by your provider health care, and 54 patients were not long-term opioids.
Patients completed electronic Daily pain diaries for 90 days. Self-reported pain levels, physical activity, fatigue and interference of daily activity-related pain were recorded, along with levels of self-reported pain relief and medication satisfaction on a scale of zero 100. patients with sickle cell and long-term treatment with opioids disease reported no pain crises intensities that were more than three times higher than those not taking opioids. During the days of pain crisis, patients receiving long-term opioid 32% also reported higher levels of pain. Chronic patients prescribed were most affected, with more than three times greater interference from pain and twice the fatigue on days without crisis, opioid therapy generally and 20% more pain interference and 33 percent increased fatigue.
The researchers also carried out some standard measures of pain processing in the test subjects, which measured and averaged variables such as participants experienced so intensely unpleasant heat and pressure. The researchers were particularly interested in the phenomenon of central sensitization, in which the central nervous system – including the brain and spinal cord – amplifies painful sensations. Central sensitization can be a way that opiates can increase sensitivity to pain, and may also play a role in the form of sickle cell disease causes chronic pain, says Carroll.
For example, one such measure of central sensitization repeated punctures uses a slightly painful stimulus in the series. In people who have this hypersensitisation each thrust is perceived as more intense than the last as the nervous system becomes progressively more sensitive to pain. The combination of data from multiple measures of central sensitization, researchers used a scoring system that sets a standard measurement 0 rates how something abnormal is so far away from the values zero. They calculated an index of central sensitization for those long-term opioid and those who did not take.
In general, patients receiving long-term opioid showed higher levels of central sensitization, with an index of 0.34, than those who were not, with a rate of -0.10, as expected Carroll.
In participants who were not on chronic opioid therapy, the level of central sensitization correlates with the level of pain no crisis. However, in patients taking chronic opioid therapy and also had higher central sensitization and clinical pain levels, the correlation essentially disappeared. Carroll says this was surprising and suggests that the mechanisms of pain in patients with sickle cell disease treated with long-term opioid may be different in an unexpected way that in patients not taking opioids for pain daily.
Carroll warns that his work is preliminary and should not lead to doctors or people with sickle cell disease to remove many need opioids to control pain unbearable. One of the biggest challenges in sickle cell disease is that doctors can not believe that patients feel pain when there is no sign of tissue damage or believe they are drug-seeking, and thus contribute to suffering.
“We need to understand better how the use of long-term opioid pain affects awareness and determine whether certain people are more sensitive to these effects so we can prescribe the best treatment for each individual patient,” says Carroll. “We also need to learn more about how sickle cell disease can sensitize the nervous system.”
According to the Centers for Disease Control and Prevention Disease Sickle cell disease affects millions of people worldwide and around 100,000 people in the United States. The frequency of hospitalizations for the treatment of pain causes sickle one of the most costly conditions to treat in the American medical system cells.
The disease originated in Africa, India and the Middle East – tropical countries where malaria is prevalent. Those who carry a single gene for the disorder known as sickle cell trait have some protection against malaria, while those who inherit two copies of the classical form and develop more severe sickle cell disease.
This article was originally published on medindia.net
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