Chronic Opioid Therapy and Central Sensitization in Sickle Cell Disease.
Chronic opioid therapy (COT) for chronic non-cancer pain is frequently debated, and its effectiveness is unproven in sickle cell disease (SCD). The authors conducted a descriptive study among 83 adult SCD patients and compared the severity of disease and pain symptoms among those who were prescribed COT (n=29) with those who were not using COT. All patients completed baseline laboratory pain assessment and questionnaires between January 2010 and June 2014. Thereafter, participants recorded daily pain, crises, function, and healthcare utilization for 90 days using electronic diaries. Analyses were conducted shortly after the final diary data collection period. Patients on COT did not differ on age, sex, or measures of disease severity. However, patients on COT exhibited greater levels of clinical pain (particularly non-crisis); central sensitization; and depression and increased diary measures of pain severity, function, and healthcare utilization on crisis and non-crisis diary days, as well as a greater proportion of days in crisis. Including depressive symptoms in multivariate models did not change the associations between COT and pain, interference, central sensitization, or utilization. Additionally, participants not on COT displayed the expected positive relationship between central sensitization and clinical pain, whereas those on COT demonstrated no such relationship, despite having both higher central sensitization and higher clinical pain. Overall, the results point out a high symptom burden in SCD patients on COT, including those on high-dose COT, and suggest that nociceptive processing in SCD patients on COT differs from those who are not.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: ccarrol1@jhmi.edu.
C Patrick
CP
Carroll
Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Sophie
S
Lanzkron
Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Carlton
C
Haywood
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Kasey
K
Kiley
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Megan
M
Pejsa
Johns Hopkins University School of Nursing, Baltimore, Maryland.
Gyasi
G
Moscou-Jackson
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jennifer A
JA
Haythornthwaite
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Claudia M
CM
Campbell
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D059333:Central Nervous System Sensitization; D059350:Chronic Pain / Q000188:drug therapy; D003863:Depression / Q000523:psychology; D003866:Depressive Disorder; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011788:Quality of Life; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid