Healthcare utilization in patients with sickle cell disease on buprenorphine for chronic pain Free

Introduction:

Patients with sickle cell disease (SCD) often experience acute and chronic pain that necessitates hospital admissions to treat vaso-occlusive episodes. Pain in SCD, which includes both nociceptive and neuropathic components, is highly complex. Recent buprenorphine (BUP) data suggest that BUP may improve SCD pain outcomes. This quality improvement study evaluates the use of BUP, a partial mu-opioid receptor agonist, as a strategy for pain management in patients with high levels of opioid use. We explore whether transitioning long-acting opioids to an opioid-sparing regimen with BUP in patients with SCD results in improved pain control as evidenced by reduction of admission and length of stay.

Methods: A retrospective electronic medical record (EMR) review was conducted to evaluate the effectiveness of a BUP pain management protocol at reducing healthcare utilization among patients with SCD. The study was performed at the University of Chicago Medical Center and included patients aged 18 years and older with a confirmed diagnosis of SCD (HbSS, HbSC, or HbSbeta0).

Patients with acute-on-chronic pain were offered BUP if they were admitted for at least 7 days on IV opioids and unable to wean despite offering Ketamine or Lidocaine, or if they had at least 2 admissions in the last 30 days. Patients on chronic opioid therapy with methadone or a prior diagnosis of opioid use disorder were excluded from the study. All 16 patients had micro-induction with BUP between 12/1/2023 and 3/1/2025. De-identified data were collected for a 6-month period before and after initiation of the protocol, when possible. Demographic variables included age, sex, and SCD genotype. Concurrent opioid utilization was assessed through prescription records, documenting daily morphine milligram equivalents (MME) for breakthrough opioid therapy.

Primary outcomes included admission (Adm) rates and average length of stay (LOS) per admission, captured from inpatient encounter records. Pre- and post-intervention data were analyzed using paired statistical comparisons to assess changes in utilization metrics after initiation of the BUP. The study was conducted under quality improvement and was not overseen by an Institutional Review Board.

Results: A total of 16 patients were included in this study. The median number of Adm per patient decreased following initiation of the BUP, from a mean of 6.8 Adm per patient in the 6 months prior to 4.1 Adm in the 6 months after implementation. The Wilcoxon signed-rank test yielded a test statistic of 20, which is below the critical value of 30for n = 16, indicating a statistically significant reduction in HR (p < 0.05).

The median LOS per Adm decreased from a mean of 9.5 days per Admto7.7 days after starting BUP. The Wilcoxon signed-rank test for LOS produced a test statistic of 24, also below the critical value of 30, confirming a significant reduction in LOS (p < 0.05).

Patients with the largest reductions in Adm frequency tended to show concurrent decreases in LOS, indicating a positive correlation between the two measures of healthcare utilization.

Conclusion: This study suggests that buprenorphine may be beneficial for managing chronic pain in patients with SCD, with the potential to reduce healthcare utilization. The statistically significant reductions in both metrics following BUP support the hypothesis that buprenorphine can offer effective analgesia when compared to previous care.

However, several limitations must be considered when interpreting these findings. The small sample size (n = 16) limits generalizability and statistical power. Additionally, the retrospective design is inherently subject to selection bias and lacks randomization. Treatment adherence varied across all patients, introducing a potential confounding variable that could influence both pain control and Adm rates. Other factors, such as access to outpatient care, psychosocial support, or disease-modifying therapies like hydroxyurea, may also have influenced outcomes.

This study provides preliminary evidence supporting the use of buprenorphine in chronic pain management for SCD. Future research should focus on prospective trials with larger and more diverse populations to further evaluate its efficacy and impact on patient-reported outcomes. Understanding the long-term effects of buprenorphine use in this population will be critical to establishing its role in comprehensive, patient-centered sickle cell care.