ASH 2025 | Non-opioid and integrative strategies for pain management during VOC in SCD

So, of course, I’d like to further expand the use of arginine, particularly in low-resource environments. We had a study with Richard Onalo at the University of Abuja where we used oral arginine to treat patients who ended up in the hospital with acute pain. And he saw a significant decrease in his length of hospital stay by nearly two days. So 46-hour difference in those who received oral arginine versus those who received placebo. So this concept of nutritional interventions, you know, there’s so much evidence out there to show that patients with sickle cell disease are low in omega-3 fatty acids, so DHA, EPA. There’s lots of data to show that they’re low in vitamin D that has consequences that affect pain. You know, magnesium, we treat them with folate because they have a folate deficiency. And so when we start, and the reason they have a folate deficiency is because of the increased turnover of their red blood cells. So, but they don’t have any one specific deficiency, right? These nutritional deficiencies never come in isolation. And we really need to start thinking about the entire picture. So nutritional approaches would be an integrative approach. There are some really promising data coming out on acupuncture and pain outside sickle cell, but also within the sickle cell field. So that’s something that I would love to see brought into the emergency department because it is, you know, it’s inexpensive and it’s also has, you know, potentially opioid-sparing effects. And there’s a group of people who are, you know, moving from studying the needles to actually studying acupressure, which I also think is really exciting because although acupuncture is, you know, seems to work, when you tell children that you’re going to stick needles in their ears, they may not necessarily embrace that concept. But acupressure is a little bit less invasive from the perspective. You know, then also there have been studies that have shown that virtual reality, and really it’s in distraction, you know, helping patients, cognitive behavior therapy, breathing exercises. There are all kinds of things that we can do and that we can borrow from the pain world and bring to our patients with sickle cell disease to help them, you know, navigate through these pain episodes that are so devastating.

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