Low-dose Buprenorphine for Pain in a Pregnant Patient With Sickle Cell Disease

Sharon Jia; Sarah Minor; Jennifer Stagg

doi:10.1016/j.jpainsymman.2025.02.158

1. Participants will be able to describe the complications of sickle cell disease and opioid use in pregnant patients and highlight the importance of pain management in a complex and vulnerable population. 2. Participants will be able to describe a low-dose buprenorphine regimen for the pregnant woman with sickle cell disease on chronic opioids, and apply the lessons learned from this case to care for future patients. We present a case of low-dose buprenorphine initiation in the pregnant patient with sickle cell disease. There is literature that describes buprenorphine use in the pregnant population, but no literature about buprenorphine use in the pregnant patient with sickle cell disease. We describe a low dose regimen and its outcomes. Sickle cell disease (SCD) causes significant morbidity and mortality, affecting approximately 100,000 people in the United States [1]. Chronic pain negatively affects quality of life and is estimated to occur in 30 to 40% of adolescents and adults with SCD [2]. Therefore, patients often rely on opioids for pain control. Management of opioid use and pain crises are further complicated when women with SCD become pregnant. Pregnancy increases the risks of pain episodes, and women with SCD face an increased risk of maternal and perinatal complications compared to the nonpregnant sickle cell population [3]. Buprenorphine has been studied in opioid use disorder and chronic pain management. There is also evidence that supports its use for opioid use disorder treatment during pregnancy [4]. Because buprenorphine functions as a partial agonist, there are fewer adverse effects such as respiratory depression and a reduced severity of neonatal abstinence syndrome [5]. In SCD, literature suggests buprenorphine is a safer alternative compared to full opioid agonists such as oxycodone or morphine. However, there is no literature on the use of buprenorphine in pregnant patients with SCD. We present a case of low-dose buprenorphine initiation in a twenty-eight-year-old woman with SCD who has been seeing the palliative care team for chronic pain management. Patient discovered she was six weeks pregnant after her eighth emergency department visit of the week for pain. After four additional emergency department visits the following week, she was admitted for management of sepsis and bacteremia. During hospitalization, palliative care was consulted to manage the patient's pain symptoms. She was transitioned from her outpatient regimen of oxycodone extended-release to sublingual buprenorphine. The buprenorphine regimen was escalated in the inpatient setting, and she was discharged on buprenorphine with oxycodone immediate-release for breakthrough pain. Further discussion of the buprenorphine regimen will follow. 1 CDC – National Center for Health Statistics – Sickle Cell Disease (SCD). https://www.cdc.gov/sickle-cell/data/index.html. September 3, 2024. 2 Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020 Jun 23;4(12):2656-2701. doi: 10.1182/bloodadvances.2020001851. PMID: 32559294; PMCID: PMC7322963. 3 Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. American Journal of Obstetrics & Gynecology, Volume 230, Issue 2, B17 - B40 4 Minozzi S, Amato L, Bellisario C, Ferri M, Davoli M. Maintenance agonist treatments for opiate‐dependent pregnant women. Cochrane Database of Systematic Reviews 2013, Issue 12. Art. No.: CD006318. DOI: 10.1002/14651858.CD006318.pub3. Accessed 09 September 2024. 5 Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711. American College of Obstetricians and Gynecologists. Obstet Gynecol 2017;130:e81–94.

Low-dose Buprenorphine for Pain in a Pregnant Patient With Sickle Cell Disease

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