Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jun 23;4(12):2656-2701.
doi: 10.1182/bloodadvances.2020001851.

American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain

Amanda M Brandow  1 , C Patrick Carroll  2 , Susan Creary  3 , Ronisha Edwards-Elliott  4 , Jeffrey Glassberg  5 , Robert W Hurley  6   7 , Abdullah Kutlar  8 , Mohamed Seisa  9 , Jennifer Stinson  10 , John J Strouse  11   12 , Fouza Yusuf  13 , William Zempsky  14 , Eddy Lang  15
Affiliations

American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain

Amanda M Brandow et al. Blood Adv. .

Abstract

Background: The management of acute and chronic pain for individuals living with sickle cell disease (SCD) is a clinical challenge. This reflects the paucity of clinical SCD pain research and limited understanding of the complex biological differences between acute and chronic pain. These issues collectively create barriers to effective, targeted interventions. Optimal pain management requires interdisciplinary care.

Objective: These evidence-based guidelines developed by the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD.

Methods: ASH formed a multidisciplinary panel, including 2 patient representatives, that was thoroughly vetted to minimize bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic reviews. Clinical questions and outcomes were prioritized according to importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment.

Results: The panel reached consensus on 18 recommendations specific to acute and chronic pain. The recommendations reflect a broad pain management approach, encompassing pharmacological and nonpharmacological interventions and analgesic delivery.

Conclusions: Because of low-certainty evidence and closely balanced benefits and harms, most recommendations are conditional. Patient preferences should drive clinical decisions. Policymaking, including that by payers, will require substantial debate and input from stakeholders. Randomized controlled trials and comparative-effectiveness studies are needed for chronic opioid therapy, nonopioid therapies, and nonpharmacological interventions.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest disclosure: All authors were members of the guideline panel or members of the systematic review team or both. As such, they completed a disclosure-of-interest form, which was reviewed by ASH and is available as Supplements 2 and 3.

References

    1. Sil S, Cohen LL, Dampier C. Psychosocial and functional outcomes in youth with chronic sickle cell pain. Clin J Pain. 2016;32(6):527-533. - PubMed
    1. Smith WR, Penberthy LT, Bovbjerg VE, et al. . Daily assessment of pain in adults with sickle cell disease. Ann Intern Med. 2008;148(2):94-101. - PubMed
    1. Darbari DS, Ballas SK, Clauw DJ. Thinking beyond sickling to better understand pain in sickle cell disease. Eur J Haematol. 2014;93(2):89-95. - PubMed
    1. Du S, Lin C, Tao YX. Updated mechanisms underlying sickle cell disease-associated pain. Neurosci Lett. 2019;712:134471. - PMC - PubMed
    1. Tran H, Gupta M, Gupta K. Targeting novel mechanisms of pain in sickle cell disease. Hematology Am Soc Hematol Educ Program. 2017;2017:546-555. - PMC - PubMed