Original ArticlesPain management in sickle cell disease*
Section snippets
Pharmacologic management of pain
The pharmacologic management of pain consists of the use of nonopioids, opioids, and adjuvant medications or co-analgesics. They may be used singly or in combination to achieve pain relief (Benjamin et al., 1999).
Home management
Painful episodes of mild severity are treated ideally at home with nonpharmacologic measures (e.g., bed rest, hydration, massage, relaxation, heating pads, tub-baths, self-hypnosis) and with nonopioid analgesics (e.g., acetaminophen, ibuprofen) or less potent opioids (e.g., oxycodone, codeine) (Ballas, 1994). Some physicians do not prescribe opioids to patients with sickle cell disease for home use (Charache, 1981), but this may cost the patient unnecessary suffering (Marks & Sachar, 1973;
APS recommendation for management of acute pain episode in sickle cell disease
“Severe pain should be considered a medical emergency, with timely and aggressive management until the pain is tolerable” (Benjamin et al., 1999, p. 37). Whether the patient is in the ED, a day hospital, or the hospital, the patient must be assessed for the cause of pain and/or complications. The selection of medication and the loading dose is based on prior history and current assessment. The patient should be asked what the usual medication, dosage, and experienced side effects were in the
Summary
The pharmacologic management strategies for pain associated with sickle cell disease consist of opioids, nonopioids, and adjuvant analgesics or co-analgesics. There were several issues and challenges related to pain management at home and in the ED, as well as concerns and fears related to addiction. The APS Clinical Practice Guideline for the Management of Acute and Chronic Pain in Sickle Cell Disease (Benjamin et al., 1999) was developed to improve pain management in patients with sickle cell
Acknowledgements
The author acknowledges the following training grants: Institutional Pre-Doctoral Award within the Nurse Training Grant in Symptom Management (T32-NR07088-01) and the National Institute of General Medical Sciences from the University of California San Francisco.
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Address correspondence and reprint requests to Eufemia Jacob, PhD(c), RN, 25865 Meadowmist Dr, Hayward, CA 94544. E-mail: [email protected]