Pain management in children and adolescents with sickle cell disease.
In a cohort of 2,194 children with sickle cell disease (SCD) treated in community-based services, we explored the types of medications used to treat vaso-occlusive (VOC) pain episodes, and the relative effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjunctive antidepressants or anticonvulsant medications on reducing acute VOC pain visits over time. Pharmacologic treatments for VOC pain consisted mainly of NSAIDs and weak opioids. Significantly more patients with more than 3 inpatient or ER VOC pain visits during their first year of SCD treatment were prescribed stronger opioids, SSRIs, SNRI/heterocyclics, and anticonvulsants. Prescription of both stronger opioids and SSRI antidepressants or anticonvulsants was significantly associated with lower cumulative rates of acute VOC pain visits over time. Using an observational study design and existing clinical data, these findings are intended to illustrate the potential clinical advantages of combining adjunctive antidepressants or anticonvulsants with primary pain medications for relief of acute VOC pain over time.
Department of Neuropsychiatry and Behavioral Science, University of South Carolina School of Medicine, South Carolina 29203, USA. Jeanette.Jerrell@uscmed.sc.edu
Jeanette M
JM
Jerrell
Avnish
A
Tripathi
James R
JR
Stallworth
D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000188:drug therapy*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*
D000894:Anti-Inflammatory Agents, Non-Steroidal