Background: Vaso-occlusive crises (VOCs) are a hallmark of
sickle cell disease (SCD) during which patients experience localized
pain. The current mainstay of treatment for SCD-related
pain syndrome is
nonsteroidal anti-inflammatory agents (
NSAIDs) and
opioid analgesics.
Opioids, however, carry a high risk of depression, addiction, and life-threatening
hypoventilation. In this study we report
weight loss through a multidisciplinary program and
bariatric surgery as an effective nonopioid modality to decrease the use of
opioids and frequency of VOCs in a patient with SCD. Case Description: A 35-year-old woman with SCD and
morbid obesity (body mass index [BMI] of 42 kg/m2) required high doses of
opioids for
pain control [870
morphine milligram equivalents (
MME) per day], and experienced monthly hospitalizations for VOCs that precluded her from working or having meaningful interpersonal relationships.
Palliative care identified that the patient had no admissions for VOCs when her BMI was <25 kg/m2. Given this observation, it was recommended to the patient that she lose weight. The patient enrolled in a multidisciplinary wellness program and underwent laparoscopic sleeve
gastrectomy. She subsequently lost 30 kg (BMI of 29 kg/m2), decreased her basal
opioid requirement by 58% (365
MME per day), and experienced no further hospitalizations for VOCs after the intervention, thereby improving her quality of life. Conclusions: The pervasive use and overreliance on
opioid analgesics in the treatment of VOCs increase morbidity and mortality among patients with SCD. This case study offers compelling evidence for
weight loss through a multidisciplinary program as an adjunctive
therapy to decrease the use of
opioids and frequency of hospitalizations for VOCs.