What are the NICE guidelines for pain control in sickle cell disease (SCD)?

Updated: May 12, 2021
  • Author: Joseph E Maakaron, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Pain control is best achieved with opioids. Morphine is the drug of choice.

The United Kingdom's National Institute for Health and Care Excellence (NICE) guidelines on sickle cell acute painful episodes (published in in 2012 and confirmed in 2014) include the following recommendations [46] :

  • Tailor the analgesic drug, dose, and administration route to the severity of the pain, the age of the patient, and any other pain medications the patient is concurrently taking for the current episode
  • Offer a bolus of a strong opioid (eg, morphine) to all patients with severe pain and all patients with moderate pain who have already taken an analgesic
  • Consider a weak opioid (eg, acetaminophen and codeine) for patients with moderate pain who have not yet had any analgesia
  • Offer all patients regular acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) by a suitable administration route, in addition to an opioid, unless contraindicated
  • Do not give meperidine for pain relief
  • Chronic opiod use may cause adverse reactions (eg, constipation, dizziness, and itching), offer laxatives, antiemetics and antipruritics as needed

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