Morphine for the Treatment of Pain in Sickle Cell DiseaseReport as inadecuate

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The Scientific World Journal - Volume 2015 2015, Article ID 540154, 10 pages -

Review Article

Stanford University School of Medicine, Stanford, CA 94305, USA

Vascular Biology Center, Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Mayo Mail Code 480, 420 Delaware Street SE, Minneapolis, MN 55455, USA

Christiana Care Health System, Department of Internal Medicine & Pediatrics, Newark, DE 19713, USA

Cardeza Foundation for Hematologic Research, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA

Received 20 August 2014; Accepted 18 November 2014

Academic Editor: Philippe Connes

Copyright © 2015 Mihir Gupta et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pain is a hallmark of sickle cell disease SCD and its treatment remains challenging. Opioids are the major family of analgesics that are commonly used for treating severe pain. However, these are not always effective and are associated with the liabilities of their own. The pharmacology and multiorgan side effects of opioids are rapidly emerging areas of investigation, but there remains a scarcity of clinical studies. Due to opioid-induced endothelial-, mast cell-, renal mesangial-, and epithelial-cell-specific effects and proinflammatory as well as growth influencing signaling, it is likely that when used for analgesia, opioids may have organ specific pathological effects. Experimental and clinical studies, even though extremely few, suggest that opioids may exacerbate existent organ damage and also stimulate pathologies of their own. Because of the recurrent and-or chronic use of large doses of opioids in SCD, it is critical to evaluate the role and contribution of opioids in many complications of SCD. The aim of this review is to initiate inquiry to develop strategies that may prevent the inadvertent effect of opioids on organ function in SCD, should it occur, without compromising analgesia.

Author: Mihir Gupta, Lilian Msambichaka, Samir K. Ballas, and Kalpna Gupta



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