The Relationship of Opioid Analgesia to Quality of Life in an Adult Sickle Cell Population

Abstract 

Background

Pain is a limiting factor in the daily life activities of sickle cell disease (SCD) patients. Although opioid analgesics are widely used, to date there have been no studies on the relationship of daily opioid use to quality of life (QoL) measures in this population.

Objective

To determine the relationship of opioid analgesia to QoL in adults with SCD.

Design

There were 185 outpatients with various SCD genotypes evaluated. Data were collected by patient interviews as well as review of medical records. QoL as determined by the Medical Outcome Study 36-item Short Form Survey (SF-36) was the main outcome measured.

Results

QoL outcomes were not lower in the classically more severe homozygous SS individuals when compared with the heterozygous SC patients. However, SF-36 scores were significantly lower in individuals using opioids daily compared with those who did not, in all age groups and for all diagnoses. When controlling for hydroxyurea use, the negative association between opioid use and QoL scores remained unchanged. QoL scores were significantly higher in those who were either on no medications or on hydroxyurea alone, as compared with those who were on opioids alone or on hydroxyurea and opioids concurrently. Disease severity scores were not different between medication groups.

Conclusions

SCD patients on daily opioids had poorer QoL scores than those who were not on opioids, independent of disease severity. Hydroxyurea had a positive impact on QoL, although that effect was not observed in patients also using chronic opioids. Prospective studies are needed to define the relationship of opioid use to QoL and the significance of the interaction of both drugs in SCD.

Keywords: Opioid analgesia, Quality of life, Sickle cell disease