Department of Family Medicine, Oregon Health & Science University, Portland, Oregon.
Department of Medicine, Division of General Internal Medicine and Geriatrics, Section of Addiction Medicine, Oregon Health & Science University, Portland, Oregon.
Pediatr Blood Cancer. 2021 Jan;68(1):e28766. doi: 10.1002/pbc.28766. Epub 2020 Oct 27.
Sickle cell disease (SCD) is a hematologic disorder defined by presence of sickle-shaped red blood cells that can occlude blood vessels and cause tissue ischemia and pain. Treating SCD pain adequately and safely is difficult given today's opioid climate. Buprenorphine-naloxone has been described as an alternative option to treat chronic pain in the adult literature; however, it historically required discontinuation of full-agonist opioids before initiation, resulting in opioid withdrawal. Herein we present two adolescents with SCD who successfully weaned off large doses of full-agonist opioids by using microdose induction of buprenorphine-naloxone in clinic, without experiencing significant opioid withdrawal. Ambulatory microdose induction may remove hurdles that otherwise would discourage patients from trying this regimen while still controlling pain safely.
镰状细胞病（SCD）是一种血液疾病，其特征是存在镰状红细胞，这些红细胞可能会阻塞血管并导致组织缺血和疼痛。在当前阿片类药物环境下，充分且安全地治疗 SCD 疼痛具有一定难度。布比卡因-纳洛酮在成人文献中被描述为治疗慢性疼痛的另一种选择；然而，在开始使用该药之前，它需要停止使用全激动型阿片类药物，这会导致阿片类药物戒断。在此，我们介绍了两名 SCD 青少年患者，他们在临床中通过微剂量诱导布比卡因-纳洛酮成功地戒掉了大剂量的全激动型阿片类药物，而没有经历明显的阿片类药物戒断。门诊微剂量诱导可能会消除其他可能会使患者不愿尝试该方案的障碍，同时仍能安全地控制疼痛。
