When is chronic opioid therapy (COT) indicated in the treatment of sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Patients with SCD who have emerging and/or recently developed chronic pain that is refractory to multiple other treatment modalities may benefit from regularly scheduled administration of opioids; this strategy is termed chronic opioid therapy (COT). According to the American Society of Hematology, COT should be considered after risk stratification using a validated tool, based on the following [89] :

  • How well the patient’s SCD is managed
  • Comprehensive assessment of behavioral risks (eg, risk factors for opioid misuse)
  • Implications of opioid tolerance on the management of acute pain episodes
  • Other known adverse effects of opioids

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