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Pain, along with swelling and fatigue, is one of the cornerstone symptoms of sickle cell disease. Children with sickle cell disease may often experience painful vaso-occlusive episodes, which require appropriate pain management. In most cases, adequate pain management consists of rehydration, rest, and analgesics. But where do opioids fit into this treatment strategy?

Common analgesics recommended to treat sickle cell disease pain include acetaminophen and nonsteroidal anti-inflammatory drugs. Moderate to severe pain may call for the use of opioids to manage pain. With the opioid epidemic becoming a focal point in the medical community over recent years, the use of opioids remains an ethical issue.

The misprescribing of opioids may contribute to an increased risk of opioid abuse and overdose deaths. Opioid overdoses were responsible for over 42,000 deaths in 2016. Due to their addictive nature, opioids should be prescribed with care to patients experiencing pain.

Studies have tested ethical frameworks to tackle ethical decision-making for treating pain from sickle cell disease. Opioid use carries a risk of misuse and dependence, especially in vital transition periods when adolescents with sickle cell disease become adults. But that does not mean opioids should be dismissed entirely.

Factors like implicit bias, health-related stigma, and potential neurocognitive impairment can present unique barriers to the right pain management plan. However, healthcare providers should aim to promote the ethical use of these powerful pain relievers [1]. The Integrated Ethical Framework for Pain Management can help identify challenges with managing pain as they come up.

One article on this framework suggests aiming for a patient-centered approach when managing pain. That way, providers can relieve pain safely and effectively while reducing the potential risks of abuse. Patients with sickle cell disease pain can be vulnerable and at risk of other complications like depression and anxiety without proper management. Therefore, pain management should be comprehensive and supportive of overall physical and mental health.

In conclusion, healthcare providers should seek to have an open discussion with their patients to identify the right pain management plan, with a focus on patient education and pain evaluation. An ethical framework can help improve patient-provider relationships and increase accountability when managing pain [2].

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[1] Carvalho, A. S., Martins Pereira, S., Jácomo, A., Magalhães, S., Araújo, J., Hernández-Marrero, P., Costa Gomes, C., & Schatman, M. (2018). Ethical decision making in pain management: a conceptual framework. Journal of Pain Research, Volume 11, 967–976. https://doi.org/10.2147/jpr.s162926

 

[2] Mulchan, S. S., Wakefield, E. O., Martin, S. R., Ayr-Volta, L., Krenicki, K., & Zempsky, W. T. (2021). Navigating ethical challenges for pediatric sickle cell pain management in the context of the opioid epidemic. The Clinical Journal of Pain, 38(2), 88–94. https://doi.org/10.1097/ajp.0000000000001007