Acute pain in children and adults with sickle cell disease: management in the absence of evidence-based guidelines

Abstract

Unfortunately, most clinical practice guidelines for the management of acute pain are not based on randomized clinical trials. As a result, our practice of pain management is primarily limited to expert opinion and inferences from observational studies. Additional clinical trials in management of acute pain in children and adults with SCD are critical for the development of evidence-based guidelines.

A 19-year-old woman with sickle cell disease and pain

“…2,9 Acetaminophen and a nonsteriodal anti-inflammatory drug should be prescribed with an opiate, unless oth- erwise contraindicated. [1][2][3]7 Patients will often have a preferred opiate that they have found, with experience, to be effective. This patient should be informed about the safe and effective use of analgesia, including initial frequent doses to control pain quickly.…”

Finally, a consensus statement on sickle cell disease manifestations: A critical step in improving the medical care and research agenda for individuals with sickle cell disease

“…The importance of including individuals with sickle cell disease cannot be overemphasized, as they provide unique insight to the severity, evolution, and resolution of sickle cell disease-related complications. We can only speculate that the inclusion of individuals with sickle cell disease, particularly when defining acute pain episodes may have resulted in a broadening of the definition proposed by Ballas et al When asked to keep a daily diary, adults with sickle cell disease report having acute pain episodes 13% of the days, yet they only seek medical attention in 4% of the days [8]. However, each of the most frequently cited publications defining acute vasoocclusive pain episodes, including the new definition by Ballas et al, require a visit to a medical facility, Table II.…”

(463) Dexmedetomidine as an adjuvant to analgesic strategy during vaso-occlusive episodes in adolescents with sickle cell disease

“…Consequently, some patients have severe pain throughout hospitalization and after hospital discharge, pain-related re-hospitalization rates are high 3,7,8 . Currently, clinicians caring for SCD patients mostly treat symptoms because mechanism-based strategies for SCD-associated pain are sorely lacking 9,10 . Further, most approaches to treat SCD pain have poor levels of evidence, being based on observational studies and on expert opinions rather than on clinical trials 9,10 .…”

“…Currently, clinicians caring for SCD patients mostly treat symptoms because mechanism-based strategies for SCD-associated pain are sorely lacking 9,10 . Further, most approaches to treat SCD pain have poor levels of evidence, being based on observational studies and on expert opinions rather than on clinical trials 9,10 . Therefore, new therapies to more effectively treat SCD pain are needed.…”