Pain management in adult acute sickle cell pain crisis: a viewpoint.
BACKGROUND
The acute pain crisis of sickle cell disease is inadequately treated in many countries.


OBJECTIVE
To present a simple protocol that controls acute pain in most adult patients within 72 hours, based on our experience in an area where sickle cell disease is highly prevalent.


METHODS
Patients aged 14 years and above with sickle cell disease presenting with pain crisis are treated initially in the Emergency Room. Those responding adequately are discharged home on oral analgesics while those with persisting pain after 6 hours are treated further, for up to 72 hours, in an Observation Unit attached to the Emergency Room. Narcotic analgesics are administered regularly for the first 24 hours.


RESULTS
Using this protocol, acute pain crisis could be terminated or controlled in over 80% of patients within 72 hours.


CONCLUSIONS
Regular intravenous narcotic analgesia for the initial 24 hours, supplemented by oral analgesia, is useful for adult patients with severe acute sickle cell pain crisis when the pain is inadequately controlled by initial Emergency Room treatment. There may be gender differences in pain perception and response in acute sickle cell pain crisis.
Udezue
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Internal Medicine Services, Al Hasa Clinical Services Division Saudi Aramco, Al Hasa Health Center, Mubarraz 31311, Saudi Arabia. manevans@yahoo.com
Herrera
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D020910:Ketorolac / Q000627:therapeutic use; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D009294:Narcotics / Q000008:administration & dosage / Q000627:therapeutic use*; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D010147:Pain Measurement
D000700:Analgesics; D009294:Narcotics; D009020:Morphine; D008614:Meperidine; D020910:Ketorolac