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Journal Article Ppublish 289 citations

PubMed: 32559294 DOI: 10.1182/bloodadvances.2020001851

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

Blood Adv 4(12):2656-2701

Authors: Amanda M Brandow, C Patrick Carroll, Susan Creary, Ronisha Edwards-Elliott, Jeffrey Glassberg, Robert W Hurley, Abdullah Kutlar, Mohamed Seisa, Jennifer Stinson, John J Strouse, Fouza Yusuf, William Zempsky, Eddy Lang

Affiliations

  • Section of Hematology/Oncology/Bone Marrow Transplantation, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
  • Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD.
  • Center for Innovation in Pediatric Practice, Division of Hematology, Oncology and Bone Marrow Transplant, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, OH.
  • Department of Pediatrics, University of Illinois at Chicago, Chicago, IL.
  • Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Department of Anesthesiology and.
  • Department of Public Health Sciences, Wake Forest School of Medicine, Winston Salem, NC.
  • Center for Blood Disorders, Medical College of Georgia, Augusta University, Augusta, GA.
  • Mayo Clinic Evidence-based Practice Research Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
  • Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
  • Division of Hematology, Department of Medicine, and.
  • Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, NC.
  • Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
  • Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT; and.
  • Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.

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.

MeSH

Cells, Disease Management, Hematology, Chronic Pain, Anemia, Sickle Cell, Pain, Pain Management, Therapeutics, Hematologic Diseases

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