Buprenorphine for Chronic Pain in a Pediatric Patient With Sickle-Cell Disease

Abstract

Sickle-cell disease (SCD) is an inherited hematologic disorder characterized by the presence of sickle-shaped red blood cells. 1 Brandow AM Carroll CP Creary S et al. American society of hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020; 4: 2656-2701https://doi.org/10.1182/bloodadvances.2020001851 Crossref PubMed Scopus (37) Google Scholar Misshapen red blood cells are rigid, which leads to occlusion of blood vessels resulting in tissue ischemia and pain. Pain can manifest as acute, intermittent episodes (vaso-occlusive crises [VOC]), chronic pain, or acute-on-chronic pain. 1 Brandow AM Carroll CP Creary S et al. American society of hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020; 4: 2656-2701https://doi.org/10.1182/bloodadvances.2020001851 Crossref PubMed Scopus (37) Google Scholar Buprenorphine is a semisynthetic opioid that has historically been used for opioid use disorder. Due to a unique receptor binding profile and favorable safety profile, including lower risk of tolerance and hyperalgesia, buprenorphine is increasingly recognized for its utility in chronic pain management, especially in complex cases. 2 Pergolizzi JV Raffa RB Safety and efficacy of the unique opioid buprenorphine for the treatment of chronic pain. J Pain Res. 2019; 12: 3299-3317https://doi.org/10.2147/JPR.S231948 Crossref PubMed Scopus (15) Google Scholar ,3 Irwin M Petersen KS Smith MA Rapid buprenorphine induction for cancer pain in pregnancy. J Palliat Med. 2020; (Published online December 4jpm.2020.0524)https://doi.org/10.1089/jpm.2020.0524 Crossref PubMed Scopus (3) Google Scholar Two small studies reported decreased healthcare utilization and daily opioid requirements in adults with chronic SCD pain transitioned from full opioid agonists to buprenorphine. 4 David M Carroll C Lauriello A Salzberg B Lanzkron S Assessing the safety and efficacy of converting adults with sickle cell disease from full agonist opioids to buprenorphine. Blood. 2018; 132: 856https://doi.org/10.1182/blood-2018-99-111435 Crossref Google Scholar ,5 Osunkwo (ify), I Veeramreddy P Arnall J et al. Use of buprenorphine/naloxone in ameliorating acute care utilization and chronic opioid use in adults with sickle cell disease. Blood. 2019; 134: 790https://doi.org/10.1182/blood-2019-126589 Crossref Google Scholar Another case series of two adolescents with chronic SCD pain described rotation to buprenorphine with improved functionality and decreased opioid requirements. 6 Buchheit BM Joslin T Turner HN Wong TE Ambulatory microdose induction of buprenorphine-naloxone in two adolescent patients with sickle cell disease. Pediatr Blood Cancer. 2020; (Published online October 27)https://doi.org/10.1002/pbc.28766 Crossref PubMed Scopus (4) Google Scholar Literature on buprenorphine for pain in pediatric patients is sparse in general and practically nonexistent for pediatric chronic SCD pain. 7 Quirk K Wright J Marks A Smith MA. Sublingual buprenorphine for pediatric cancer pain: a case report and review of the literature. J Pain Symptom Manage. 2020; 60: 1055-1058https://doi.org/10.1016/j.jpainsymman.2020.07.029 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Here, we report buprenorphine induction for chronic pain in a pediatric patient with SCD.