What are the NHLB recommendations for pain management in the treatment of 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

In the United States, 2014 recommendations from an expert panel convened by the National Heart, Lung, and Blood Institute for treatment of pain in patients experiencing a vaso-occlusive crisis included the following [50] :

  • Initiate analgesic therapy within 30 minutes of triage, or 60 minutes of registration
  • Whenever possible, use an individualized prescribing and monitoring protocol (written by the patient’s SCD provider) or an SCD-specific protocol
  • In patients with mild to moderate pain, continue treatment with NSAIDs in those who report relief with these agents, unless contraindicated
  •  In patients with severe pain, rapidly initiate treatment with parenteral opioids
  • Calculate the opioid dose on the basis of the patient’s current short-acting opioid dose being taken at home
  • Administer opioids subcutaneously if intravenous access is not obtainable
  • Reassess pain every 15-30 minutes until the patient reports that pain is under control; readminister opioids if necessary for continued severe pain
  • Reassess for pain relief and monitor for adverse effects after each dose
  • Maintain the opioid dose or consider escalation by 25% until pain is controlled
  • Administer opioids by around-the-clock patient-controlled analgesia (PCA) or frequently scheduled doses rather than on an as-requested (prn) basis
  • In patients receiving PCA, continue long-acting oral opioids unless these agents need to be withheld to prevent oversedation
  • At discharge, titrate off the parenteral opioids before conversion to oral opioids, and adjust the home dose of long- and short-acting opioids to prevent opioid withdrawal
  • Do not use meperidine unless it is the only effective opioid for that patient
  • Use oral NSAIDs as an adjuvant analgesic, unless contraindicated
  • Prescribe oral antihistamines for patients who require these agents for itching from opioids; give repeat doses every 4-6 hours, if needed, rather than with each dose of opioid

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