Chronic pain in the aging adult with sickle cell disease

Improved survival in sickle cell disease (SCD) has led to a growing population of older adults who experience a high burden of chronic pain. With aging, pain often shifts from episodic vaso-occlusive crises to persistent, multifactorial syndromes driven by cumulative tissue injury, central sensitization, and progressive organ damage. This evolution presents significant clinical challenges, particularly in the context of comorbidities, polypharmacy, and age-related physiological changes. This narrative review examines the epidemiology, pathophysiology, and management of chronic pain in aging adults with SCD. Key contributors to pain include musculoskeletal degeneration, neuropathic mechanisms, and chronic inflammation, compounded by renal, hepatic, and cardiovascular dysfunction. Pharmacological management requires careful consideration of analgesic safety, particularly with opioids, nonsteroidal anti-inflammatory drugs, and adjuvant agents. Nonpharmacological approaches, including rehabilitative and behavioral strategies, are essential components of care. Psychosocial factors and health disparities further influence pain experiences and treatment outcomes. A multidisciplinary, individualized approach integrating geriatric and SCD-specific principles is critical to improving quality of life in this vulnerable population.