Evaluating Buprenorphine as an Alternative to Opioids for Chronic Pain Management in Sickle Cell Disease: A Scoping Review
Alejandro Hallo-Carrasco, MD1; María Albuja, MD2; Grace Bazile, MLIS 2; Nivetha Srinivasan, MD1; Aditi Maste, MD1; Haijun Zhang, MD1; Andrew Kaufman, MD1; Christine Hunt, DO 3; Moiz Kasubhai, MD 2
1Rutgers New Jersey Medical School – Anesthesiology Department; 2Lincoln Medical Center – Internal Medicine Department; 3Mayo Clinic – Pain Medicine Department
Introduction
•Despite concerns about side effects and tolerance, high doses of short-acting opioid agonists continue to be commonly prescribed for pain management, leading to opioid dependence, increased acute care use, and greater strain on healthcare resources.
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•This scoping review explores the potential of buprenorphine, a partial opioid agonist, as a promising alternative for managing chronic pain in patients with sickle cell disease (SCD), particularly those with opioid use disorder.
Methods
•Following the registered protocol on OSF (doi.org/10.17605/OSF.IO/7D4GS), we conducted a scoping review following PRISMA guidelines to explore the use of buprenorphine in managing SCD-related pain. We included English-language studies on adults up to March 2023.
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•Data from multiple databases were assessed by two reviewers, focusing on study type, participant demographics, pain management strategies, and outcomes related to hospital admissions.
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•Since only published data was used, IRB approval was not required.
Results
•A total of 7 studies met inclusion criteria and underwent qualitative analysis. Among the included studies four were retrospective, one was a case report, and one was an interview study
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•These studies involved 473 patients, predominantly African American females (median 68%), with a mean age of 34.4 years.
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•Transition protocols often required complete discontinuation of full opioids before initiating buprenorphine, with some studies recommending a mild withdrawal phase.
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•Buprenorphine dosing ranged from 2-4 mg sublingually initially, adjusted based on withdrawal symptoms, with higher doses (≥16mg daily) linked to improved adherence.
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•Buprenorphine use led to significant reductions in emergency department visits (from 9.1 to 4.2 per year) and hospital stays (from 5.8 to 2.8 days).
Conclusions
Our review suggests that the partial mu-agonist buprenorphine offers a promising alternative to traditional mu-agonist opioid medications, with evidence pointing its potential for reducing the amount of traditional opioids needed during disease crisis, improving quality of life, and managing chronic pain more effectively in patients with SCD.
References
•Karafin MS. Predictive factors of daily opioid use and quality of life in adults with sickle cell disease. Hematology 2018
•Leyde S. Transition from Oxycodone to Buprenorphine/Naloxone in a Hospitalized Patient with Sickle Cell Disease: A Case Report. J Gen Intern Med 2022
•David M. Assessing the Safety and Efficacy of Converting Adults with Sickle Cell Disease from Full Agonist Opioids to Buprenorphine. Blood 2018
