Pain and opioid use after reversal of sickle cell disease following HLA-matched sibling haematopoietic stem cell transplant
The burden of pain varies among patients with sickle cell disease (SCD). Chronic pain, resulting from multiple aetiologies, is common in SCD. The Analgesic, Anaesthetic, and Addiction Clinical Trial Translations Innovations Opportunities and Networks-American Pain Society Pain Taxonomy (ACTTION-AAPT) criteria have recently described subcategories of chronic SCD pain (Dampier et al, 2017). Haematopoietic stem cell transplant (HSCT) is the most accessible curative therapy for SCD resulting in disease-free survival in over 85% (Hsieh et al, 2014; Gluckman et al, 2017). After successful HSCT (as defined by haematological parameters), most patients are weaned off opioids; however, a subgroup of patients continues to experience pain that requires opioid treatment.
We determined the prevalence and correlates of pain requiring continued opioid treatment at 12 months after successful non-myeloablative human leucocyte antigen-matched sibling allogeneic HSCT in a cohort of SCD patients (Fig 1) (Hsieh et al, 2014). The Institutional Review Board of the National Institutes of Health approved the protocol. All participants provided informed consent. Detailed data on the clinical course, pain, opioid use and laboratory values were prospectively collected within 3 months prior to HSCT and at 12 months post-HSCT (n = 35). Patient Reported Outcomes Measurement Information System (PROMIS) measures were also prospectively collected at the same time points in a subgroup of these patients (n = 20). The PROMIS domains assessed included pain intensity, pain impact, anxiety, depression, satisfaction with social role, physical function, fatigue and sleep disturbance (Cella et al, 2007; Keller et al, 2017). All PROMIS raw data were converted to T-scores.Continue Reading