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Sickle cell disease

26 August 2009

Painkillers in the management of sickle cell disease assessed

The first UK based research project assessing the management of acute pain in sickle cell disease has been commissioned by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme. Sickle cell disease is an inherited disorder of red blood cells, which affects over 12,000 people in the UK.

'Sickle' red blood cells change shape on giving up oxygen and can lose water. These cells block small blood vessels, causing ‘pain crisis’ and long term damage to organs. Severe ‘pain crisis’ usually leads to hospital admission, and treatment with opioids such as morphine. However, morphine is associated with side effects including nausea, constipation, itching, and mood changes. Previous research has suggested non-steroidal anti-inflammatory drugs may be effective although this is limited.

The research team, led by Dr Kofi A Anie of North West London Hospitals, are looking at a combination of ibuprofen and morphine through 'patient controlled analgesia’ (PCA) in adults with sickle cell ‘pain crisis’ who have been admitted to hospital. The study is being developed with input from patients with sickle cell disease, the Sickle Cell Society, and carried out jointly with the MRC Clinical Trials Unit, and a group of hospitals in North West London, including Central Middlesex and Hammersmith Hospitals.

"Morphine can lead to a number of additional complications so it is important that better ways to manage sickle cell pain are identified. A number of studies have been conducted outside the UK and some have shown non-steroidal anti-inflammatory drugs to be promising, complementary to the use of opioids” says Dr Anie. “We hope our study will show that taking ibuprofen in addition to morphine reduces the use of morphine and related side effects for sickle cell pain treated in hospital, as well as potentially improving patients' experience. This could also lead to a reduction in NHS costs related to frequent hospital admissions."

"Pain management for people with sickle cell disease is a very serious challenge, with around 90 per cent of hospital admissions, reportedly, due to acute pain," says Dr Asa'ah Nkohkwo, Chief Executive of the Sickle Cell Society. "This research is extremely timely as a recent national survey found that there is a lack of understanding among health workers and clinicians as to the use of opioids, such as morphine in sickle cell disease pain management. The results of this trial could have a real impact on practice."