Nonopioid Pharmacological Therapies for Acute SCD Pain

For pediatric and adult patients with acute SCD-related pain, the panel suggested a short course of nonsteroidal anti-inflammatory drugs for 5 to 7 days in addition to opioids for acute pain management (conditional recommendation based on very low certainty in the evidence about effects).

For pediatric and adult patients who present with acute SCD-related pain, the panel suggested against the use of corticosteroids for acute pain management (conditional recommendation based on low certainty in the evidence about effects).

For pediatric and adult patients with acute SCD-related pain who are hospitalized, the panel suggested a subanesthetic (analgesic) ketamine infusion as adjunctive treatment for pain that is refractory or not effectively treated with opioids alone (conditional recommendation based on very low certainty in the evidence about effects).

Nonpharmacological Therapies for Acute SCD Pain

For pediatric and adult patients with SCD who seek treatment for acute pain, the panel suggested massage, yoga, transcutaneous electrical nerve stimulation, virtual reality, and guided audiovisual relaxation in addition to standard pharmacological management (conditional recommendation based on very low certainty in the evidence about effects).


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Pain Management in an SCD-Specific Hospital-Based Acute Care Facility

For pediatric and adult patients who develop episode of acute pain that require hospital care, the panel suggests the use of SCD-specific hospital-based acute care facilities over typical emergency department-based care (conditional recommendation based on low certainty in the evidence about effects).

Chronic Transfusion Therapy for the Treatment of Recurrent Acute Pain and/or Chronic Pain

For pediatric and adult patients with SCD who have recurrent acute pain, the panel suggested against chronic monthly transfusion therapy as a first-line treatment for the prevention and reduction of recurrent pain episodes (conditional recommendations based on low certainty in the evidence about effects).

These new guidelines include more and extensive recommendations for the management of SCD-related pain using nonopioid-based pharmacological and nonpharmacological therapies. In addition, they also provide stronger guidance on personalized opioid dosing for acute pain.

The ASH panel noted that low or very low certainty in the evidence about effects for several of their key recommendations highlights limitations to these guidelines. Additionally, limited direct evidence was available among individuals living with SCD to base these recommendations off of. The scarcity of direct evidence lead the panel to focus on indirect evidence available.

“The application of the indirect evidence will increase awareness for interventions that may have a positive impact on treating acute and chronic SCD pain that otherwise would not have been considered,” the guideline authors wrote.

To enhance chronic opioid therapy, nonopioid therapy, and nonpharmacological interventions, randomized controlled trials and comparative-effectiveness analyses are essential.

“In conclusion, there is significant variability in the approach to pain management in individuals with SCD and a paucity of direct evidence upon which to base recommendations,” the authors wrote.

“The hope is that these guidelines will provide structure around the management of acute and chronic SCD pain and identify areas of research needed that incorporate important patient-centered outcomes with the ultimate goal of decreasing pain-related suffering for individuals living with SCD.”

Reference

Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic painBlood Adv. 2020;4(12):2656-2701.

This article originally appeared on Hematology Advisor