Assessment of a standardized pain management protocol for adult patients with sickle cell disease.

OBJECTIVE: To evaluate the impact of a standardized pain management protocol on prescribing practices for opioids, nonopioid therapies, and disease-modifying agents among adult patients with sickle cell disease (SCD) in an outpatient setting. DESIGN: A retrospective analysis comparing prescribing patterns before and after the implementation of a standardized pain management protocol. SETTING: An adult sickle cell clinic at an academic medical center. PATIENTS/PARTICIPANTS: A total of 165 adult patients diagnosed with SCD receiving outpatient care. INTERVENTIONS: Implementation of a multidisciplinary team-developed standardized pain management protocol for assessing and managing pain and psychological distress in patients with SCD. MAIN OUTCOME MEASURE(S): Changes in opioid prescribing patterns (including median morphine equivalent daily dose [MEDD]), prescribing of nonopioid therapies, eg, antidepressants, anticonvulsants, nonsteroidal anti-inflammatory drug (NSAIDs), prescribing of disease-modifying agents (hydroxyurea), and pain scores. RESULTS: Following protocol implementation, the proportion of patients prescribed opioids decreased to 91.5 percent (p = 0.03). Although no significant change occurred in median MEDD, prescribing of nonopioid therapies significantly increased, including hydroxyurea (57.5 percent vs 21.2 percent, p < 0.01), antidepressants, anticonvulsants, and NSAIDs. Pain scores decreased slightly but not significantly. CONCLUSIONS: The standardized outpatient pain management protocol has the potential to reduce opioid usage and increase the adoption of evidence-based nonopioid therapies in patients with SCD. Further validation in diverse clinical settings is warranted to assess the protocol's long-term effectiveness and outcomes.