Management of vaso-occlusive pain in children with sickle cell disease.
OBJECTIVE
A descriptive, longitudinal design was used to evaluate the pain management strategies used in children with sickle cell disease who were experiencing pain during a vaso-occlusive episode.


METHODS
A list of the medications (name, amount, mode of delivery, and frequency) prescribed and administered for pain management for each participant was recorded on the Medication Quantification Scale Worksheet, starting from day 1 of hospitalization to the day of discharge. Children were asked once each evening to provide three separate ratings of how much the pain medication helped them during the day, evening, and night using a 0-to-10 rating scale.


RESULTS
Using patient-controlled analgesia (PCA), children self-administered only 35% of the analgesic medications that were prescribed and reported little pain relief. No significant relationships were found between changes in pain relief scores and the amount of analgesics administered.


CONCLUSIONS
Clinicians need to monitor the amount of analgesics delivered in relationship to pain relief and assist children to titrate PCA administration of analgesics to achieve optimal pain control, or to advocate for changes in the PCA regimen when children cannot assume control of pain management.
Jacob
Eufemia
E
Department of Hematology/Oncology, Texas Children's Cancer Center, Houston, Texas 77030, USA. exjacob@txccc.org
Miaskowski
Christine
C
Savedra
Marilyn
M
Beyer
Judith E
JE
Treadwell
Marsha
M
Styles
Lori
L
D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000523:psychology / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000755:Anemia, Sickle Cell / Q000150:complications*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004155:Diphenhydramine / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology* / Q000503:physiopathology; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008137:Longitudinal Studies; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D017060:Patient Satisfaction; D012646:Self Administration; D017211:Treatment Failure
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D009020:Morphine; D004155:Diphenhydramine; D020910:Ketorolac