SHM Converge Scientific Abstract ePoster Gallery-Suboxone for Chronic Pain in a Sickle Cell Patient

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This case report describes a 46-year-old man with sickle cell disease and end-stage renal disease who had severe chronic pain from T8–T10 compression fractures due to renal osteodystrophy/tertiary hyperparathyroidism. He experienced repeated prolonged hospitalizations because pain was so uncontrolled that he could not perform activities of daily living.<br /><br />Standard opioid treatment failed because he needed more narcotics than could be safely prescribed outside the hospital, and several adjunctive pain medications (gabapentin, methocarbamol, baclofen, ketamine) were not tolerated because of side effects. The team therefore initiated buprenorphine-naloxone (Suboxone) inpatient using a microdosing schedule, starting at very low doses and gradually increasing over several days until adequate pain control was reached. Hydromorphone remained available as needed for breakthrough pain.<br /><br />By discharge, the patient was able to bathe, shower, and walk short distances, showing meaningful functional improvement.<br /><br />The discussion highlights that Suboxone, though FDA-approved for opioid use disorder, can also be effective off-label for chronic pain. Its partial mu-opioid agonist and kappa-antagonist properties may provide analgesia with less respiratory depression and lower tolerance risk than full opioid agonists. Microdosing is useful because it avoids forcing the patient into opioid withdrawal during initiation, though it may require a longer hospital stay and clinician familiarity.<br /><br />The authors conclude that Suboxone is a promising option for chronic pain in sickle cell patients, especially when full opioid agonists are ineffective or poorly tolerated. Microdosing can be learned by hospitalists and may improve pain control in the acute setting.

Asset Subtitle

Clark Robinson

Meta Tag

Author List Clark Robinson, Eden Mae Rodriguez, Stephanie Y. Terauchi

Category Clinical Vignettes

Concept Buprenorphine-Naloxone

Concept Chronic Pain

Concept Microdosing

Concept Sickle Cell Disease

Concept Opioid Withdrawal

Distinguished Non-Finalist

Presenter Organization UT Southwestern

Presenting Author Clark Robinson

Track Adult

Keywords

sickle cell disease

end-stage renal disease

chronic pain

buprenorphine-naloxone

Suboxone

microdosing

opioid tolerance

renal osteodystrophy

tertiary hyperparathyroidism

compression fractures

Buprenorphine-Naloxone

Chronic Pain

Microdosing

Sickle Cell Disease

Opioid Withdrawal