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."
To view the full project
details visit www.hta.ac.uk/1782
