A Qualitative Phenomenological Study of Treatment Options for Patients with SCD and Chronic Pain: Buprenorphine-Naloxone or Full-Agonist Therapy.

Data in sickle cell disease (SCD) shows that 30-50% of adults have chronic pain. Chronic pain is a life-shaping condition that is often inadequately managed with chronic opioid therapy (COT). Buprenorphine-naloxone (bup-nal) is an alternative (to COT), yet patient perspectives on its use remain limited. This is a phenomenological qualitative study exploring how adults with SCD experience chronic pain and consider treatment options including COT and bup-nal. Semi-structured interviews were conducted with 26 adults with SCD and chronic pain who were offered pain management with bup-nal, including individuals who declined or discontinued treatment. Participants described pain as a constant, embodied experience around which they structured their daily functioning, relationships, well-being, and treatment. Those receiving bup-nal consistently reported improved daily functioning, greater independence, enhanced mood, and reduced healthcare utilization. In contrast, participants not receiving bup-nal described ongoing pain interference, reduced daily functioning, and continued reliance on acute care services. Importantly, participants emphasized functional improvement and stability, rather than pain elimination, as the most meaningful outcomes. These findings suggest that buprenorphine-naloxone may shift pain from a dominant, disabling experience to a more manageable condition that improves participation in work, relationships, and daily activities. To optimize management of chronic pain in SCD, it is necessary to align treatment with patient priorities.