Chronic Pain Leads to Higher Opioid Doses and Lower QoL in Sickle Cell Patients

In adults with sickle cell disease, higher daily opioid use may be associated with poorer health-related quality of life.

In adults with sickle cell disease, higher daily opioid use may be associated with poorer health-related quality of life (HRQoL), according to a study published in Hematology.

Adult patients with sickle cell disease often experience a complex chronic pain syndrome that is frequently treated with long-term opioid regimens. However, the literature is sparse regarding the connection between daily opioid use and patient HRQoL.

A total of 99 adult patients with sickle cell disease (65% women; median age, 30 years; 78% sickle cell hemoglobin, 22% sickle cell-hemoglobin C) were enrolled in a cross-sectional cohort trial between January 2014 and July 2017. They were administered the Patient Health Questionnaires-15 (PHQ-15) and -9 (PHQ-9), along with the Medical Outcome Study 36 Item Short Form (SF-36) and Generalized Anxiety Disorder-7 surveys.

Medical chart review provided patients’ daily outpatient opioid regimens, and chronic pain was defined as pain experienced ≥3 days per week over 6 months or daily opioid use to manage pain. All doses were converted into morphine milligram equivalents (MME), with a dichotomous cutoff separating participant intake into dose groups of <90 MME/day (low dose; n=50) or ≥90 MME/day (high dose; n=49). Survey scores and daily opioid dose were examined, and multivariable regression analysis was performed using demographics, clinical characteristics, and HRQoL results as variables.

The overall median opioid dose was 80 MME/day. Individuals in the high vs low opioid dose group had higher levels of chronic pain (96% vs 36%, respectively; P <.0001), lower SF-36 scores on 7 of 8 subscales (P <.0001 to P =.13), and lower physical and mental summaries (P =.02 and P = .03, respectively). In addition, compared with the low opioid dose group, the high-dose group had a greater somatic burden as assessed with the PHQ-15 (P <.0001), more anxiety as evaluated with the General Anxiety Disorder Questionnaire-7 (P =.006), and worse depression, as assessed with the PHQ-9 (P =.002).

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Regression analysis indicated that chronic pain was the strongest predictor of higher daily opioid dosage (P <.0001). In patients reporting chronic pain, there were 3 other important predictors of opioid use ≥90 MME/day: low SF-36 mental summary score (P =.002), elevated PHQ-15 score (P =.012), and decreased SF-36 physical summary score (P = .042).

Study limitations include an inability to establish causality among chronic pain, higher opioid dosages, and reduced HRQoL, as well as the use of questions from the 4 surveys, which omitted information on pain history and modulation.

“Although many adults with [sickle cell disease have] severe daily pain, our data suggest that these higher daily opioid doses may not meaningfully improve the quality of life for these patients,” concluded the study authors.

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Karafin MS, Singavi A, Hussain J, et al. Predictive factors of daily opioid use and quality of life in adults with sickle cell disease [published online May 31, 2018]. Hematology. doi:10.1080/10245332.2018.1479997