Evidence Supporting Alternative Parenteral Routes of Opioid Administration for Pain Management in Sickle Cell...

Sickle cell disease (SCD) is an autosomal, recessive, genetic disorder that affects the structure and function of the hemoglobin. Pain is the hallmark of SCD, and opioids and nonsteroidal anti-inflammatory drugs are the mainstay of SCD pain control during vaso-occlusive crisis (VOC). Intravenous (IV) access is mostly used for opioid administration in emergency departments. Most people with SCD often need frequent venipuncture for IV access for medications, fluids, and transfusions. The frequent venipuncture sometimes damages their veins, making it difficult to establish or maintain IV access for therapies during VOC, prompting the need for alternative parenteral routes of opioid administration for pain management. This article aims to summarize existing evidence on alternative routes of opioid administration to provide support for their use in acute SCD-related pain. Literature search for human studies was conducted through Pubmed, Ovid, ProQuest, EBSCOHost, Scopus, National Institute of Medicine, Google Scholar, and governmental agency websites. Systematic reviews, randomized control trials, cohort studies, and clinical guidelines published in English between 1984 to 2025 were included. Future clinical research should be conducted on the safety and effectiveness of using alternative routes of opioid administration in individuals with SCD.