Sickle cell pain & methadone

Children with sickle cell disease frequently have painful episodes that can require hospitalization for a few days. Physicians want to treat those episodes quickly to eliminate pain and get a child back home and back to school as quickly as possible, and now, researchers at Washington University School of Medicine in St. Louis have found that using the drug methadone might eliminate the pain more quickly. Methadone frequently is used to treat cancer pain and is a well-known treatment for addiction. But it also may be useful treating the severe pain associated with sickle cell disease.

TREATING PAIN FROM SICKLE CELL DISEASE CAN BE DIFFICULT. CHILDREN WITH THE DISEASE OFTEN HAVE SEVERE PAIN EPISODES THAT CAN REQUIRE HOSPITALIZATION. BUT NOW RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE AND ST. LOUIS CHILDREN’S HOSPITAL HAVE FOUND THAT ADDING METHADONE TO OTHER PAIN KILLERS CAN RELIVE SICKLE CELL PAIN MORE QUICKLY IN CHILDREN AND MAY BE ABLE TO HELP YOUNGER PATIENTS GET HOME FROM THE HOSPITAL SOONER. JIM DRYDEN HAS THE STORY

IT’S NOT UNCOMMON FOR PATIENTS WITH SICKLE CELL DISEASE TO HAVE PAIN EPISODES THAT LAND THEM IN THE HOSPITAL. SIXTY PERCENT HAVE AT LEAST ONE SUCH EPISODE, CALLED A VASO-OCCLUSIVE EPISODE, EACH YEAR. ABOUT ONE IN FIVE HAVE MULTIPLE EPISODES ANNUALLY THAT REQUIRE HOSPITALIZATION. BECAUSE THE DRUG METHADONE HAS BEEN EFFECTIVE AS A TREATMENT FOR CANCER PAIN, WASHINGTON UNIVERSITY EMERGENCY MEDICINE SPECIALIST JENNIFER HORST AND HER COLLEAGUES DECIDED TO SEE HOW IT WORKED IN PATIENTS WITH PAIN FROM SICKLE CELL DISEASE.

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Methadone is a medication that is used a lot with patients with other types of chronic pain, such as cancer patients. There are some patients with sickle cell disease who have received methadone, but it’s a small minority. And it’s not one of the typical pain medications.

CHILDREN, AND ADULTS, WITH SICKLE CELL DISEASE HAVE VASO-OCCLUSIVE EPISODES WHEN THE SHAPE OF THEIR RED BLOOD CELLS BECOMES ALTERED.

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There is a problem with their red blood cells, and under certain circumstances – such as illness or dehydration or, sometimes, of unknown causes – the red blood cells change shape. And we call it sickle; they’re in a sickle shape. And whenever the red blood cells change shape, they do not flow through the blood vessels as well and cannot give oxygen to the tissue as well, and that’s what causes pain.

HORST WORKED WITH WASHINGTON UNIVERSITY ANESTHESIOLOGIST EVAN KHARASCH IN TESTING METHADONE IN SICKLE CELL PATIENTS. THEY FOLLOWED 24 CHILDREN AND ANOTHER 23 ADULTS WHO HAD BEEN HOSPITALIZED FOR PAIN. EVERYONE GOT STANDARD PAIN-KILLING DRUGS, BUT HALF OF THE KIDS AND ADULTS ALSO GOT A SINGLE, LOW DOSE OF METHADONE ON THEIR FIRST DAY IN THE HOSPITAL.

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Because this pain medication has a faster onset and lasts longer than other, typical pain medicines, we hoped that we would be able to either prevent them from being admitted to the hospital – which would be the most ideal thing, that they’d be able to go home – or that if they had to be admitted, they would be able to resolve their pain crises more quickly and be discharged home.

IN THE CHILDREN, THE SINGLE, LOW DOSE OF METHADONE RESULTED IN BETTER PAIN RELIEF THAN THE STANDARD PAIN-KILLING DRUGS THAT KIDS NORMALLY GET.

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There is not a lot of data on how methadone works in children, and so that was one of the things we were looking at. What we have found is that methadone is longer lasting than other pain medicines that would typically be used, and also has a faster onset. And so, the pain could be treated more quickly, and the pain relief would last longer.

BUT IN ADULTS, HORST SAYS, THERE WASN’T AS MUCH OF A DIFFERENCE BETWEEN PATIENTS WHO GOT METHADONE AND THOSE WHO DIDN’T.

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Part of the study was to make sure that we could give this medication in a safe manner, and so we used lower doses than one would probably typically give to treat pain. And so that might be why the adults did not have the improvement in pain scores that we would liked to have seen.

THE NEW STUDY IS PUBLISHED IN THE JOURNAL PEDIATRIC BLOOD & CANCER. I’M JIM DRYDEN...

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