Sickle cell anaemia (SCA) is the most common single genetic disorder with pain being the commonest manifestation. It is usually difficult to separate sickle cell anaemia with recurrent episodes of pains. Due to the nature of severe persistent chronic pain, those with SCA are exposed to several medications which might have some deleterious effect on health.
General attitude of health providers and care givers as well as the subject or client having SCA may serve as the stimulus or push towards drug dependence.
Studies have shown that over half of sickle cell patients have 1– 2 episodes annually. Hospital admissions for acute painful episodes have been reported to be a predictor of prognosis. Moreover, half of those hospital admissions are readmitted within 1 month after discharge.
Studies have also shown that 55% of patients with SCD reported pain on more than half of the diary days and 29% on 95% of days. Risk for mortality in adults with SCD increases for patients with increased rates of painful episodes. Hence the need for proper pain management.
Causes of pains: sudden onset pains: bone crises, acute chest syndrome, hepatic crises, gall bladder stone, hand and foot swelling,
Long standing pains: Avascular necrosis (destruction of bone around the hip joints), leg ulcer or wound, infection of bones ( Chronic osteomyelitis)
Some pains might be due to damage to the nervous system or abnormal communication within nervous system (neuropathic pain). This type of pain can be seen also diabetes mellitus, nerve traction or compression etc.
Pain secondary due to treatment: withdrawal symptoms, loose prosthesis after surgery or even post-operative pains.
The above causes of pains in subjects with SCA may lead to the use of both pharmacological and non-pharmacological modalities of pain relief.
SCA pain is usually not completely influenced by the underlying conditions but also by psychological, cultural, social and even spiritual factors. The degree of response to pains varies from person to person and also depends on disease severity.
Drug dependence and abuse is very easy to develop and very difficult to overcome, especially when one has a chronic medical condition that requires some form of pain management therapy.
The term drug abuse or addiction is commonly misconstrued in majority of instances leading to labeling those without addiction as having one. Sometimes, pseudo-addiction is confused for addiction.
Substance abuse is a pattern of recurrent use that leads to damaging consequences. This may involve failure to meet one’s major role responsibilities (e.g., as student, worker, or parent), putting oneself in situations where substance use is physically dangerous (e.g., mixing driving and substance use), encountering repeated problems with the law arising from substance use, or having recurring social or interpersonal problems because of substance use.
Substance abuse may continue for a long period or progress to substance dependence a more severe disorder associated with tolerance and withdrawal symptoms or compulsive use of substance.
In Tolerance, there is physical habituation to a drug resulting from frequent use such that higher doses are needed to achieve same effect. While withdrawal symptoms occur when dependent person abruptly stops using a particular substance following heavy use.
Vomiting , headaches, anxiety, depression, dizziness etc
Treatment of substance abuse include, a vast array of professional, biological, and psychological approaches to substance abuse and dependence. However, treatment has often been a frustrating endeavor.
Most times patients with sickle cell anaemia become dependent on pentazocine and tramadol in our environment. Mostly due to easy access and traditional practice of using them as pain relivers.
Usually the help of a psychiatrist or psychologist is often sought. But self-control strategies that can be used include: removing substances from home, not socializing with others with substance abuse
Frequenting substance free environment e.g concert, gym, religious places, socializing with non-abusers; managing internal triggers, setting gradual substance reduction schedules and making abuse more laborious.
Health professionals should ensure rapid assessment of painful crises with pain chart, initial treatment should aim at rapid pain control, periodic assessment with rating and categorizing pain with possible modification or change of drugs, use of staggered analgesia and lastly tapering doses as pain reduces.
Non-drug control of pains: distractions, relaxation, massage, music, self-motivation, heat or warm compress are means of controlling pain without the by use of medication.
Following the above, will reduce the incidence of substance abuse.