Clinical Case Examples Research Articles

Assessment of Cerebrovascular Reserve in the Setting of Moyamoya Disease Using Arterial Spin-Labeling and Acetazolamide Challenge

Arterial spin-labeling is a safe, noninvasive, contrast-free MR imaging technique that can be used to assess CBF. In this review, we will briefly discuss the advantages and disadvantages of arterial spin-labeling juxtaposed to previously established modalities of cerebral perfusion imaging, summarize the materials and methods required for arterial spin-labeling, and provide clinical case examples in which application of arterial spin-labeling combined with an acetazolamide challenge was used safely to improve patient outcomes in the setting of Moyamoya disease. Arterial spin-labeling takes advantage of the directionality of arterial blood flow by labeling the patient's own endogenous water within the neck via radiofrequency pulse and imaging of the downstream brain after an appropriate delay. This tool allows repeatable intra- and intersession estimation of CBF to better assess postinterventional outcomes in patients with cerebrovascular dysfunction. One specific example of the utility of arterial spin-labeling is its application in patients with Moyamoya disease by selection and stratification of those most likely to benefit from surgical intervention. The combination of arterial spin-labeling with acetazolamide challenge is an effective way to assess cerebrovascular reserve in Moyamoya disease and is easily adaptable on a clinical 3T MR imaging scanner using a commercially available arterial spin-labeling pulse sequence to generate augmentation and steal maps. The entire study can be completed in only 20 minutes in a routine clinical setting.Learning Objective: To describe the implementation and interpretation of arterial spin-labeling combined with an acetazolamide challenge

The course of multidrug-resistant pulmonary tuberculosis in HIV-infected people with COVID-19

Aim. To analyze the course of multidrug-resistant tuberculosis (MDR-TB) in HIV-infected people, depending on the time to COVID-19 diagnosis, using the example of clinical cases from our own observation. Materials and methods. The article presents 3 clinical cases of our own observation of MDR-TB in HIV-infected persons depending on the time to COVID-19 diagnosis in patients, who were treated in the Pulmonary Tuberculosis Department No. 2, clinical base of the Department of Tuberculosis and Pulmonology ZSMU – Municipal non-profit enterprise “Zaporizhzhia Regional Phthisiopulmonology Clinical Medical and Diagnostic Center” of Zaporizhzhia Regional Council. Results. In clinical case 1, in an HIV-infected patient, MDR TB was detected after COVID-19. This clinical case has shown that after mild and treated COVID-19, even on the background of severe immunosuppression, but with AMBT and ART timely prescribed, MDR-TB in the patient had a favorable course with positive dynamics. In clinical case 2, in an HIV-infected patient, MDR-TB was detected concomitantly with COVID-19. The clinical case indicated that the patient received all 3 therapies for MDR-TB, HIV and COVID-19 in full and on time. In contrast to clinical case 1, the patient was diagnosed with a more severe process that required a longer period of treatment, although it was effective. In clinical case 3, an HIV-infected patient with COVID-19 was diagnosed after 5 months of MDR-TB treatment. Against this background, there was culture positivity. But after prescription of appropriate COVID-19 treatment against the background of AMBT and ART, positive dynamics and culture negativity were determined. All 3 patients completed antimycobacterial therapy of MDR-TB with results – recovery. Conclusions. Regardless of the HIV infection duration with underlying severe immunosuppression (<200 CD4 lymphocyte cells) and the time to COVID-19 diagnosis (before, during or after the diagnosis of MDR-TB) on the background of timely therapy of MDR-TB, HIV and COVID-19, positive results can be achieved while saving the lives of patients.

Child Parent Relationship Therapy: Reunification with Children and Parents with Substance Use Disorders

ABSTRACT Exposure to parental substance use disorder (SUD) has significant and lasting effects on the development of children emotionally, physically, within the educational environment, as well as within the parent-child relationship. The separation of parent and child within families with SUDs is commonplace as child protective services involve due to the increased frequency of child abuse, neglect, and criminal activity. To date, no specific reunification approach for working with parents with SUDs has been identified or suggested. Given that child parent relationship therapy (CPRT) centers on enhancing secure attachment between parents and children and promoting parents’ understanding of the needs of their children, the authors discussed CPRT as an innovative intervention with parents with SUDs to reestablish or establish a healthy connection with their children. A brief clinical case example was given followed by implications for clinicians.

Brain Functional Imaging Anatomy.

Human brain function is an increasingly complex framework that has important implications in clinical medicine. In this review, the anatomy of the most commonly assessed brain functions in clinical neuroradiology, including motor, language, and vision, is discussed. The anatomy and function of the primary and secondary sensorimotor areas are discussed with clinical case examples. Next, the dual stream of language processing is reviewed, as well as its implications in clinical medicine and surgical planning. Last, the authors discuss the striate and extrastriate visual cortex and review the dual stream model of visual processing.

Clinical observations of generalized and inoperable locally advanced forms of basal cell carcinoma

Background. Basal cell carcinoma (BCC) occupies around 80% of all the cases of diagnosed skin cancer (according to American Cancer Society). In various countries of the world the morbidity rate of BCC differs due to the main predisposing factor of BCC development – ultraviolet radiation. In Ukraine, according to National Cancer Registry, 15882 new cases of non-melanoma skin cancer were registered in 2019–2020. Standardized morbidity rate of this pathology increased by 2,6% compared to 2018. Basal cell cancer commonly recurs (according to different experts, the rate varies from 10% to 80%), at the same time, distant metastases are diagnosed quite rarely. Understanding contribution of Hedgehog (Hh) signaling pathway to carcinogenesis of BCC has become a serious achievement in molecular biology. In spite of relatively benign course of BCC and variety of treatment methods of this disease, there is a high risk of recurrence, and in some patients, lesions may progress to such extent that they become unsuitable for local therapy which makes it urgent to search for alternatives to surgery and radiation therapy.
 Purpose – to study the peculiarities of course, treatment, development of complications of recurrent, locally advanced, metastatic inoperable BCC by the example of clinical cases. Materials and methods. Clinical observation of female patient K., 73 years old, who was undergoing treatment in the Department of Clinical Oncology and Hematology by reason of multiple BCC lesions (observation time 14 years) and female patient D., 42 years old, who was undergoing treatment in the Department of Radiation Pathology and Palliative Care by reason of aggressive course of locally advanced form of basalioma (observation time 29 years). Observation and treatment were performed in the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine».
 Results. The clinical cases of observation and different stages of treatment of patients with constantly recurring aggressive BCC over a long period of time, 14 and 29 years, are demonstrated. Metastasing of BCC is confirmed in both cases, local advancement is shown, various methods of treatment were used: surgery, radiation therapy, cryodestruction, chemotherapy. Difficulty of patients' management is shown, especially when all available methods are used up. Treatment of complications of special therapy methods, multistage restoring plastic surgeries using different methods of plastic repair are described.
 Conclusions. Treating recurrent, metastatic, and locally advanced inoperable forms of BCC when one runs out of possibilities of the main treatment methods – surgery, radiation therapy, chemotherapy is a difficult task which requires further development of modern technology and treatment methods.

Pharmacogenetic testing in schizophrenia in real clinical practice: before or after antipsychotic -induced adverse drug reactions development?

IntroductionSchizophrenia is socially significant mental disorder characterized by early onset and high time and financial expenditure on treatment. Antipsychotics (APs) are highly effective against positive and negative symptoms, but at same time have a wide range of adverse drug reactions (ADRs). APs efficiency and safety are variable and depend on characteristics of genetically determined mechanisms (transportation, biotransformation, and elimination).ObjectivesInvestigation role of pharmacogenetic testing (PhGT) on example of clinical case of severe ADRs in 47-year-old woman with schizophrenia.MethodsPatient’s medical history analysis; clinical observation; biochemical serum analysis; therapeutic drug monitoring; PhGT.ResultsThe clinical case of a woman with schizophrenia who has been noted to be unresponsive to APs for some years after schizophrenia onset. She was found to be homozygous for nonfunctional SNVs CYP2D6*4 and CYP2C9*2, heterozygous for CYP1A1*2A, which was reason for complete shutdown of isoenzymes 2D6, 2C9 and 1A1 activity and development of ADRs in use of initial doses of several APs, as well as for an increase in severity of ADRs with schizophrenia positive symptoms aggravation with an even slower titration of APs daily dose not only with polytherapy, but also with monotherapy. So, not recommented APs for patient: aripiprazole, haloperidol, zuclopenthixol, cariprazine, quetiapine, paliperidone, risperidone, thioridazine, sertindole, asenapine, alimemazine, chlorpromazine, etc. (CYP2D6); haloperidol, clozapine, olanzapine, perphenazine, promazine (CYP2C9); carefully: haloperidol, olanzapine, perospirone (СYP1A1).ConclusionsThis rare case demonstrates PhGT importance before APs therapy, because the patient had very high risk AP – induced ADRs. She needed PhGt before APs use, but not after severe ADRs during 12 years.DisclosureNo significant relationships.

Surgical anatomy of minimally invasive lateral approaches to the thoracolumbar junction.

The thoracolumbar (TL) junction spanning T11 to L2 is difficult to access because of the convergence of multiple anatomical structures and tissue planes. Earlier studies have described different approaches and anatomical structures relevant to the TL junction. This anatomical study aims to build a conceptual framework for selecting and executing a minimally invasive lateral approach to the spine for interbody fusion at any level of the TL junction with appropriate adjustments for local anatomical variations. The authors reviewed anatomical dissections from 9 fresh-frozen cadaveric specimens as well as clinical case examples to denote key anatomical relationships and considerations for approach selection. The retroperitoneal and retropleural spaces reside within the same extracoelomic cavity and are separated from each other by the lateral attachments of the diaphragm to the rib and the L1 transverse process. If the lateral diaphragmatic attachments are dissected and the diaphragm is retracted anteriorly, the retroperitoneal and retropleural spaces will be in direct continuity, allowing full access to the TL junction. The T12-L2 disc spaces can be reached by a conventional lateral retroperitoneal exposure with the rostral displacement of the 11th and 12th ribs. With caudally displaced ribs, or to expose T12-L1 disc spaces, the diaphragm can be freed from its lateral attachments to perform a retrodiaphragmatic approach. The T11-12 disc space can be accessed purely through a retropleural approach without significant mobilization of the diaphragm. The entirety of the TL junction can be accessed through a minimally invasive extracoelomic approach, with or without manipulation of the diaphragm. Approach selection is determined by the region of interest, degree of diaphragmatic mobilization required, and rib anatomy.

Dem belly full but we hungry: culinary spaces and Black masculinity

The author draws some parallels between food, symbolism, and identity and argues that disturbances in eating patterns represent a specific type of defence against oppression and commodification of the body. Discussing the development of cuisine in place and eating patterns of Jamaican men specifically, the author considers the psycho-biography of the Caribbean and the impact of traumatic loss. Exploring the development of recipes and the foodways of Jamaican cuisine from the perspective of self-care and the creation of culture to mitigate the impact of loss of identity and in parallel with disturbances in feeding and eating patterns. After discussing the emergence of cuisine in place, the author then examines: (1) how slavery has shaped contemporary feeding and eating habits; (2) the relationship between food, Afro-Caribbean men and culture; and (3) the ways that his-torical events have been turned into “edible narratives” illuminating adaptive meaning-making processes. A clinical case example shows how environmental factors may impact on identity, creating eating and feeding disturbances which might arise in the clinical setting and how these may be thought about.

Clinical case study of abbreviated cognitive behavioral therapy through an intersectional lens for women health-care workers during the era of COVID-19.

The unprecedented demands of the coronavirus 2019 disease (COVID-19) have imposed a significant degree of psychological distress on women health-care workers (WHCWs). Women comprise 76% of the health-care workforce in the United States and are subject to experience higher psychosocial ramifications in the pandemic era due to gender disparities. Accordingly, women who are dually mothers may be navigating complex interactions of role strain by managing abnormally high parental and occupational workloads. The psychological toll is exacerbated for women holding multiple oppressed identities across domains such as economic status, race and ethnicity, gender identity, sexual orientation, and other identities of salience. To address WHCWs' unique needs during the COVID-19 pandemic, the authors present a clinical case example through an intersectional framework illustrating how an abbreviated, 4-session cognitive behavioral therapy model may be implemented to support women disproportionally affected by social and systemic factors with a focus on sexism and discrimination against mothers for this particular participant. This case study describes the treatment of a patient in an integrated women's health clinic to demonstrate how to clinically support WHCWs while promoting social justice and gender-based equity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MURDEROUS MYTHOMANIA: Psychopathology of lying – Apropos a Clinical Case

IntroductionThe capacity for lying is a common human phenomenon with evolutionary explanations, in which one seeks to deceive usually to avoid harmful or undesired consequences. The spectrum of lies is vast and varies from the content to the motivation. Pathological lying has the potential to affect mental evaluations thus motivating an important discussion regarding this behaviour.ObjectivesThe authors aim to explore the psychopathological concept and spectrum of pathological lies, from their underlying motives to their implications and challenges in psychiatric diagnosis with recourse to a clinical case example.MethodsA review of pertinent literature on the topic with focus on that which is most relevant to the theme was included. The authors present the clinical case of a middle-aged female who presented with mythomania which included the fabrication of having attempted murder.ResultsThe literature demonstrates a relationship between compulsive lying and personality disorders. Head trauma and other central nervous system issues may also play a role. Some traits may facilitate the detection of deception, such as dramatic and unmotivated constructs with a positive self-portrayal. The clinical case description correlates the personality factors associated with mythomania, namely antisocial personality disorder, differing from the typical presentation as her fabrications portrayed her negatively.ConclusionsThe implication of pathological lying is that it may interfere with mental assessment thus altering, by way of deception, the psychiatric evaluation as lies may be difficult to detect upon a first evaluation. The psychiatrist should be alerted to the possibility of fabrication when dealing with a patient with predisposing factors.DisclosureNo significant relationships.

Применение PACK-кросслинкинга при инфекционных кератитах и неэффективности местной консервативной терапии (клинические случаи)

Purpose. To present the results of PACK (Photo-Activated Chromophore for Keratitis) treatment of infectious keratitis with ineffective drug therapy using the example of clinical cases. Material and method. Under observation were 6 patients aged 28–55 years (5 men and 1 woman) with infectious keratitis (bacterial, viral-bacterial, acanthamoeba-bacterial, fungal). All of them received no effect within 5 weeks – 2.5 months. drug therapy (local and systemic) at the place of residence. All patients underwent PACK crosslinking. Results. Complete relief of the process was observed in all patients within 4–7 weeks (on average, after 39.2 days). As a result of treatment, in half of the patients (3 out of 6) visual acuity increased to 0.4–0.8, in 3 patients it did not change significantly after treatment and corresponded to light perception with the correct projection of light – 0.01–0.02, since the inflammatory process ended with severe corneal clouding. Conclusion. Corneal PACK crosslinking appears to be an effective and promising technique for the treatment of infectious keratitis resistant to ongoing drug therapy. In cases of the outcome of the infectious process with the formation of persistent and pronounced clouding (thorn) in such patients in the «cold» period after the arrest of the infectious process, keratoplasty with an optical purpose can be performed. Key words: infectious keratitis, drug therapy failure, PACK crosslinking, optic keratoplasty

Rhythmic Relating: Bidirectional Support for Social Timing in Autism Therapies.

We propose Rhythmic Relating for autism: a system of supports for friends, therapists, parents, and educators; a system which aims to augment bidirectional communication and complement existing therapeutic approaches. We begin by summarizing the developmental significance of social timing and the social-motor-synchrony challenges observed in early autism. Meta-analyses conclude the early primacy of such challenges, yet cite the lack of focused therapies. We identify core relational parameters in support of social-motor-synchrony and systematize these using the communicative musicality constructs: pulse; quality; and narrative. Rhythmic Relating aims to augment the clarity, contiguity, and pulse-beat of spontaneous behavior by recruiting rhythmic supports (cues, accents, turbulence) and relatable vitality; facilitating the predictive flow and just-ahead-in-time planning needed for good-enough social timing. From here, we describe possibilities for playful therapeutic interaction, small-step co-regulation, and layered sensorimotor integration. Lastly, we include several clinical case examples demonstrating the use of Rhythmic Relating within four different therapeutic approaches (Dance Movement Therapy, Improvisational Music Therapy, Play Therapy, and Musical Interaction Therapy). These clinical case examples are introduced here and several more are included in the Supplementary Material (Examples of Rhythmic Relating in Practice). A suite of pilot intervention studies is proposed to assess the efficacy of combining Rhythmic Relating with different therapeutic approaches in playful work with individuals with autism. Further experimental hypotheses are outlined, designed to clarify the significance of certain key features of the Rhythmic Relating approach.

Pathfinder; alternative care pathways for older adults who phone the emergency medical services in North Dublin: a case study

Purpose Emergency Department (ED) presentations in older people are associated with a wide range of adverse events, which increase the risk of lengthy hospitalisation and poor outcomes. Pathfinder is an inter-organisational initiative delivered in partnership between Beaumont Hospital Occupational Therapy and Physiotherapy departments and the National Ambulance Service. Pathfinder responds to non-serious and non-life-threatening emergency medical service (EMS) calls. This study aims to demonstrate how Pathfinder can safely treat a proportion of older people at home by using alternative care pathways (ACPs), therefore avoiding unnecessary ED presentations. Once a decision has been reached to treat the person at home, the Pathfinder follow-up team delivers functional rehabilitation and case management in the persons’ home over the subsequent days. Design/methodology/approach This paper outlines the Pathfinder assessment, management and interventions in one clinical case example. Outcome measures include the level of patient satisfaction obtained via routine telephone feedback questionnaire and re-presentation to Beaumont Hospital within 30 days. Findings This paper illustrates through a case example the benefit of a collaborative multi-disciplinary rapid response team for non-serious and non-life-threatening EMS calls in older adults. The patient in this case example had no further EMS calls or ED presentations for 30 days after Pathfinder intervention and reported a high level of satisfaction with the service. Research limitations/implications ED presentation was avoided through comprehensive multi-disciplinary assessment, including immediate access to intensive follow-up support in the person’s own home. Practical implications The Pathfinder service is improving access to ACPs for older people in the Beaumont Hospital catchment area. Pathfinder will now be spread nationally, with local adaptation, so that older people in other parts of Ireland will also benefit from this integrated model of care. Originality/value Patient feedback surveys confirm older adults want access to alternative care pathways.

Disorder of the intestinal microbial tissue complex after a new coronavirus infection as an interdisciplinary problem

The occurrence of diarrhea in comorbid patients with COVID-19 infection against the background of microbiocenosis disorders may be a factor in the worse outcome of the disease. The biggest threat posed by diarrhea is dehydration. Evaluation, control and timely correction of disorders of the gastrointestinal tract, allowing to identify signs associated with dehydration, impaired water and electrolyte balance, intestinal microecology and phenomena of increased epithelial permeability. It is important to consider the risk of diarrhea in patients undergoing massive therapy for COVID-19. On the example of a specific clinical case, the most common mistakes in managing patients with acute/persistent diarrhea are analyzed. The tactics of managing a patient with diarrheal syndrome after a COVID-19 infection has been defined and substantiated, the importance of a holistic approach to solving patient problems from the standpoint of the one health concept has been substantiated.

Piloting the Update: The Use of Therapeutic Relationship for Change - A Free Energy Account.

We apply the Free Energy Principle (FEP) to cognitive behavioral therapy (CBT). FEP describes the basic functioning of the brain as a predictive organ and states that any self-organizing system that is in equilibrium with its environment must minimize its free energy. Based on an internal model of the world and the self, predictions—so-called priors—are created, which are matched with the information input. The sum of prediction errors corresponds to the Free Energy, which must be minimized. Internal models can be identified with the cognitive-affective schemas of the individual that has become dysfunctional in patients. The role of CBT in this picture is to help the patient update her/his priors. They have evolved in learning history and no longer provide adaptive predictions. We discuss the process of updating in terms of the exploration-exploitation dilemma. This consists of the extent to which one relies on what one already has, i.e., whether one continues to maintain and “exploit” one’s previous priors (“better safe than sorry”) or whether one does explore new data that lead to an update of priors. Questioning previous priors triggers stress, which is associated with increases in Free Energy in short term. The role of therapeutic relationship is to buffer this increase in Free Energy, thereby increasing the level of perceived safety. The therapeutic relationship is represented in a dual model of affective alliance and goal attainment alliance and is aligned with FEP. Both forms of alliance support exploration and updating of priors. All aspects are illustrated with the help of a clinical case example.

A Critical, Relational Approach for Working with Suicide in Family Therapy

Suicidality is a major global public health issue that couple and family therapists will inevitably encounter in their clinical work. While relational therapies for addressing suicidality are growing, few specifically outline ways to address the influence of systemic oppression on suicidality, reflecting the push to de‐politicise suicide research. To address this issue, scholars have proposed integrating narrative approaches with evidence‐based practices. This paper therefore delineates the integration of narrative therapy with dialectical behaviour therapy as a material discursive therapy. All main aspects of theory integration are described, including the epistemological framework, approach to the therapeutic relationship, and interventions. Finally, the change process is described using clinical case examples throughout to illustrate the ways in which these models can be integrated to produce a critical, relational approach for addressing suicidality in family therapy.

Rehabilitation in Overhead Athletes With Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a clinical diagnosis resulting from the impingement of neurovascular structures between the clavicle and first rib. Effective prevention and nonoperative treatment in high-performance athletes with TOS are not well documented. The objective of reporting this case was to discuss the symptom progression, relevant clinical findings, and rehabilitation of an overhead athlete with diagnosed neurogenic TOS. Numerous rehabilitative techniques may be used to treat an athlete with TOS, with an emphasis on restoring full shoulder mobility, motor control, and normalized scapular mechanics in a throwing athlete, as well as improving functional thoracic range of motion. Modalities such as neuromuscular electrical stimulation and targeted muscle exercises are incorporated in the process. In the case presented, a collegiate-level throwing athlete returned to full participation at her previous level of play within 18 weeks of rehabilitation initiation. This report details the clinical findings and treatment options available to address pathology in an overhead athlete with a diagnosis of TOS. The clinical case example shows techniques that may help guide the clinician in establishing effective nonoperative or postoperative treatments for TOS. Level of EvidenceLevel V, expert opinion.

An Algorithmic Approach to Managing Parotid Duct Injury Following Buccal Fat Pad Removal.

The principles of achieving an aesthetically pleasing and harmonious facial appearance are influenced by our evolving understanding of the three-dimensional topography of the face coupled with novel approaches to midface volumization and contouring. In parallel with the evolving landscape of facial aesthetic surgery, an increasing number of publications have emerged focusing on the role of intraoral buccal fat pad removal (BFPR) for the purposes of aesthetic midface contouring. The authors sought to emphasize an underreported and potentially preventable and untoward complication involving iatrogenic parotid duct injury following BFPR. The purpose of this publication is 3-fold: (1) to review the relevant anatomy and literature on intraoral BFPR, (2) to present a case example of this complication, and (3) to discuss treatment options as part of a proposed management algorithm. The authors detail the surgical indications for performing BFPR and review the relevant anatomic considerations. Complication prevention strategies are outlined, and details regarding avoidance of parotid duct injury are reviewed. The diagnostic criteria and clinical presentation of parotid duct injuries following BFPR are comprehensively outlined. The authors present a clinically actionable algorithm for managing a suspected or diagnosed parotid duct injury following BFPR. A clinical case example is discussed to highlight this complication, the diagnostic criteria, and the systematic and algorithmic approach to management. Intraoral BFPR is an incredibly valuable and powerful procedure that can improve facial contour in patients with buccal lipodystrophy or buccal fat pad pseudoherniation. The authors propose a proper diagnostic approach and treatment algorithm to manage this untoward complication.Level of Evidence: 5

ПОРАЖЕНИЕ РЕСПИРАТОРНОГО ТРАКТА ПРИ БОЛЕЗНИ КРОНА У РЕБЕНКА 6 ЛЕТ

The article is devoted to rare extraintestinal manifestations of Crohn's disease (CD) in children, primarily to the respiratory tract. A review of the literature on this problem in children's practice is presented. On the example of clinical case, data on the classification, pathogenesis, clinical picture, diagnosis, differential diagnosis and treatment of CD with respiratory tract damage in a young child are summarized.

Navigating Ethical Challenges for Pediatric Sickle Cell Pain Management in the Context of the Opioid Epidemic.

The aim was to describe the impact of the opioid epidemic on pain management practices in pediatric sickle cell disease (SCD) and propose a conceptual framework for navigating ethical decision-making in pediatric sickle cell pain management. A review of the literature on ethical challenges in the management of sickle cell pain was conducted and considered in the context of the opioid epidemic and psychosocial factors affecting youth with SCD. The Integrated Ethical Framework for Pain Management (IEFPM) was applied to pediatric sickle cell pain management using a clinical case example. Implicit bias, health-related stigma, and potential neurocognitive impairment all present unique challenges in ethical decision-making for youth with SCD. National guidelines for prescribing opioid medication may complicate providers' clinical decision-making and affect their sickle cell pain management practices. The IEFPM was found to be applicable to ethical decision-making for pediatric sickle cell pain and captures both patient-related and provider-related aspects of clinical pain management. The opioid epidemic has exacerbated existing ethical challenges for pain management among youth with SCD. The IEFPM provides a conceptual model that can be integrated into health care settings to facilitate ethical decision-making and promote greater health equity in the clinical management of pediatric sickle cell pain.