Original ArticlesNavigating Ethical Challenges for Pediatric Sickle Cell Pain Management in the Context of the Opioid EpidemicMulchan, Siddika S. PsyD*,†; Wakefield, Emily O. PsyD*,†; Martin, Sarah R. PhD‡; Ayr-Volta, Lauren PhD*,†; Krenicki, Kayla BA§; Zempsky, William T. MD, MPH*,†Author Information *Connecticut Children’s, Hartford †Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT ‡Department of Anesthesiology & Perioperative Care, University of California, Irvine School of Medicine, Orange, CA §Department of Psychology, Southern Connecticut State University, New Haven, CT W.T.Z. is a consultant for GSK and Glycomimetics, and a member of the Data and Safety Monitoring Board for Lundbeck. The remaining authors declare no conflict of interest. Reprints: Siddika S. Mulchan, PsyD, Center for Cancer and Blood Disorders, Connecticut Children’s, 282 Washington Street, Suite 5A, Hartford, CT 06106 (e-mail: [email protected]). The Clinical Journal of Pain: February 2022 - Volume 38 - Issue 2 - p 88-94 doi: 10.1097/AJP.0000000000001007 Buy Metrics Abstract Objectives: The aim was to describe the impact of the opioid epidemic on pain management practices in pediatric sickle cell disease (SCD) and propose a conceptual framework for navigating ethical decision-making in pediatric sickle cell pain management. Methods: A review of the literature on ethical challenges in the management of sickle cell pain was conducted and considered in the context of the opioid epidemic and psychosocial factors affecting youth with SCD. The Integrated Ethical Framework for Pain Management (IEFPM) was applied to pediatric sickle cell pain management using a clinical case example. Results: Implicit bias, health-related stigma, and potential neurocognitive impairment all present unique challenges in ethical decision-making for youth with SCD. National guidelines for prescribing opioid medication may complicate providers’ clinical decision-making and affect their sickle cell pain management practices. The IEFPM was found to be applicable to ethical decision-making for pediatric sickle cell pain and captures both patient-related and provider-related aspects of clinical pain management. Discussion: The opioid epidemic has exacerbated existing ethical challenges for pain management among youth with SCD. The IEFPM provides a conceptual model that can be integrated into health care settings to facilitate ethical decision-making and promote greater health equity in the clinical management of pediatric sickle cell pain. Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.