Sickle Cell Disease - Complications

The most dangerous side effect of high doses of opioids, especially morphine, is depression of breathing function. This can occur some time after the drug has been administered, and so patients must be watched closely and monitored during treatment.

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Other side effects of opioids are vomiting and nausea, itching, and problems urinating. If the patient vomits or becomes nauseated, the doctor may administer prochlorperazine (Compazine). Devices have been developed to allow patients to administer their own painkillers as needed.

Anti-Inflammatory Drugs. Because of the potentially serious side effects of opioids, doctors are constantly searching for safer and easier ways of reducing the severity of pain of sickle cell crises. Because experts believe that inflammation is a major contributor to the pain of sickle cell disease, drugs that reduce inflammation are being studied.

Prescription-strength NSAIDs, including diflunisal (Dolobid) or ketorolac (Toradol), are under investigation. Ketorolac may be particularly helpful in relieving bone pain, and may be effective for individuals who cannot tolerate opioids. In one study, it was superior to meperidine and had fewer side effects. Studies have suggested, however, that when used as first-line therapy in an acute crisis, ketorolac is effective only in about half of episodes.
Corticosteroids are powerful anti-inflammatory drugs that are commonly used to treat pain caused by inflamed muscles and joints. Such drugs include methylprednisolone (Medrol) and dexamethasone (Decadron, Hexadrol). Studies are reporting that using these drugs along with opioids may help some sickle cell patients. In one study, children who were given methylprednisolone and morphine had a shorter period of severe pain and required less morphine to control the pain than those given morphine alone. These children, however, had more recurrent attacks after medication was withdrawn than those treated with opioids alone. Because steroids can suppress the body's infection fighters, they should not be given to patients with bacterial infections or any serious medical complication.

Epidural Anesthesia. An epidural analgesia (injection of an anesthetic into the spinal fluid) may be very effective for pain that is unresponsive to the usual therapies.

Stimulants. Some doctors report that stimulants, such as methylphenidate (Ritalin) and dextroamphetamine, may enhance the pain-killing effects of opiates and counteract the sleepiness they cause. Clinical studies are needed to confirm possible benefits, however.