Elsevier

Pain Management Nursing

Volume 2, Issue 4, December 2001, Pages 121-131
Pain Management Nursing

Original Articles
Pain management in sickle cell disease*

https://doi.org/10.1053/jpmn.2001.26297Get rights and content

Abstract

The unpredictable, recurrent, intense, and frequently persistent nature of pain associated with sickle cell disease poses a difficult challenge in terms of management. A wide variability exists in the way painful episodes are managed. Variations in practice reflect different views about the suitability of opioids, the efficacy of parenteral administration, and the risk of dependence on opioids. Consequently, the acute and chronic pain associated with sickle cell disease often is undertreated or inappropriately managed. Although medical staff fear that patients might abuse pain medication and become psychologically dependent, patients are more concerned about the side effects associated with analgesics. Some patients may persuade staff to give them more analgesics, engage in clock-watching, and request specific medications or dosages; these patients often are perceived as manipulative or demanding. However, these patients are knowledgeable about their medications and doses that have worked in the past. Requests for specific medications and dosages should not be interpreted as indications of drug-seeking behavior, but clinicians should communicate with these patients, make accurate assessments, and provide adequate doses of opioid analgesics. The American Pain Society recognized that the undertreatment of pain and inappropriate management of pain in sickle cell disease seem to be common. A Clinical Practice Guideline was developed to provide evidence-based recommendations that could potentially improve pain management. The purpose of this report is to describe the pharmacologic strategies used to manage pain associated with sickle cell disease, examine issues and challenges related to pain management as well as concerns and fears related to addiction, and explain the administration of opioids as recommended by the American Pain Society. © 2001 by the American Society of Pain Management Nurses

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]

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