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Navigating Ethical Challenges for Pediatric Sickle Cell Pain Management in the Context of the Opioid Epidemic

Siddika S Mulchan1,2, Emily O Wakefield1,2, Sarah R Martin3

  • 1Connecticut Children's, Hartford.

The Clinical Journal of Pain
|November 22, 2021
PubMed

Insights

The opioid epidemic complicates pain management for pediatric sickle cell disease (SCD). An ethical framework aids decision-making, addressing bias and stigma to improve care for youth with SCD.

Area of Science:

  • Pediatric Hematology
  • Medical Ethics
  • Public Health

Background:

  • The opioid epidemic presents significant challenges to pain management in pediatric sickle cell disease (SCD).
  • Ethical considerations in managing sickle cell pain are complex, influenced by psychosocial factors and provider biases.
  • Existing guidelines for opioid prescribing may inadvertently impact clinical practices for youth with SCD.

Purpose of the Study:

  • To examine the opioid epidemic's influence on pain management strategies for pediatric sickle cell disease.
  • To propose a conceptual framework for ethical decision-making in pediatric sickle cell pain management.

Main Methods:

  • Literature review on ethical challenges in sickle cell pain management within the context of the opioid epidemic.
  • Application of the Integrated Ethical Framework for Pain Management (IEFPM) to pediatric SCD pain using a clinical case.

Main Results:

  • Implicit bias, health-related stigma, and neurocognitive issues create unique ethical decision-making challenges for youth with SCD.
  • National opioid prescribing guidelines can complicate provider decision-making and affect pain management practices.
  • The IEFPM effectively addresses both patient and provider factors in pediatric sickle cell pain management.

Conclusions:

  • The opioid epidemic intensifies ethical dilemmas in managing pain for youth with SCD.
  • The IEFPM offers a valuable model for healthcare settings to enhance ethical decision-making and promote health equity in pediatric sickle cell pain care.
Abstract

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