What is the optimal opioid analgesic in the management of sickle cell pain crisis?

Abstract

Sickle cell disease is an autosomal recessive disorder that is common in people of African, Middle-Eastern and Mediterranean ancestry and its incidence varies from 10 to 40% of the population across equatorial Africa. The homozygous sickle cell disease affects about 2% of neonates in Nigeria and accounts for 25% of deaths in children under 5 years in Africa annually. The most common clinical manifestations are pain and anaemia. Pain associated with sickle cell pain crisis is usually severe, requiring treatment with strong opioids in addition to other interventions such as oxygen therapy and hydration with isotonic solutions. In order to accommodate the complex bio-psychosocial components of this condition, pharmacotherapy, psychotherapy, functional restoration and other non-opioid pharmacotherapies need to be integrated in a multidisciplinary protocol for optimal outcome. There is a dearth of studies on the ideal analgesic regimen in the management of sickle cell crisis. Adoption of morphine PCA as the Gold standard in this condition is derived from studies on acute pain management protocols that are non-specific for sickle cell pain crisis. More research is needed to identify the most appropriate opioid analgesic protocol in the management of sickle cell pain crisis. Such study requires exploration of alternative methods of opioid administration as PCA equipment may not be universally accessible in places (especially, resource-limited settings) where sickle cell disease is most endemic.