Buprenorphine for Children and Adolescents with Sickle Cell Disease: A Scoping Review

Background and Objective: Sickle cell disease (SCD) is an inherited blood disorder associated with recurrent painful crises. Sickle cell pain crises are a significant source of distress for patients and contribute substantially to hospital utilization among SCD populations. Many children with SCD also experience chronic pain, which is often multifactorial in nature. The management of both acute and chronic pain in SCD commonly relies on opioid medications. Acute and chronic use of opioids is associated with health risks and potential complications, which has raised interest in alternatives. Buprenorphine is a partial μ-receptor agonist with strong affinity that confers pain relief and may have an improved side-effect profile. While there is emerging evidence for its use in adult patients, the data is less developed in pediatrics. Methods: A scoping review was designed in accordance with PRISMA guidelines to systematically explore the literature on buprenorphine use in pain management for children with sickle cell disease (SCD). Results: This review shows that the published literature in this area is of low quality and extremely limited, and there is a lack of trials specifically designed to address the use of buprenorphine for this patient population. Studies are limited in their generalizability but suggest that buprenorphine may be useful in managing pain in this population. Conclusions: While promising, more data is required both retrospectively and prospectively to understand the utility of buprenorphine. The development of pediatric-specific protocols for transitioning from full µ-receptor agonist opioids to buprenorphine is also needed.