What are the ASH guidelines on the treatment of acute pain in patients with sickle cell disease (SCD)?

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

For patients with SCD presenting to an acute care setting with acute pain related to SCD, ASH strongly recommends rapid (within 1 hour of emergency department [ED] arrival) assessment and administration of analgesia with frequent reassessments (every 30 to 60 minutes) to optimize pain control. The panel notes that non-intravenous (IV) routes of administration (eg, subcutaneous and intranasal) can facilitate rapid analgesic treatment.

When opioid therapy is indicated for acute pain in the acute care setting, ASH suggests using tailored opioid dosing, based on consideration of baseline opioid therapy and prior effective therapy. The panel notes that individualized care plans that include medications and doses that are effective for a given patient can be embedded in the electronic medical record and used to guide opioid dosing.

For patients with acute pain related to SCD, ASH guideline panel suggests a short course (5 to 7 days) of nonsteroidal anti-inflammatory drugs (NSAIDs) in addition to opioids, in the absence of significant risk factors for NSAID use.

ASH suggests against corticosteroids for management of SCD-related acute pain.

For hospitalized patients with SCD-related acute pain that is refractory or not effectively treated with opioids alone, ASH suggests a subanesthetic (analgesic) ketamine infusion as adjunctive treatment, in centers with the appropriate expertise to administer the drug. The recommended dose in this setting starts at 0.1 to 0.3 mg/kg per hour with a maximum of 1 mg/kg per hour.

For patients with SCD-related acute localized pain that is refractory or not effectively treated with opioids alone, ASH suggests regional anesthesia treatment approaches (ie, epidural or peripheral nerve catheter-delivered analgesia for abdominal, hip, or leg pain).

ASH does not offer a recommendation for or against IV fluids in addition to standard pharmacological management for the treatment of acute pain.

ASH suggests massage, yoga, transcutaneous electrical nerve stimulation (TENS), virtual reality (VR), and guided audiovisual (AV) relaxation in addition to standard pharmacological management for acute pain.

ASH chooses not to offer a recommendation for or against acupuncture or biofeedback for the treatment of acute pain in addition to standard pharmacological management.

For patients who develop acute pain episodes requiring hospital care, ASH suggests using SCD-specific hospital-based acute care facilities (ie, day hospitals and infusion centers, that have appropriate expertise to evaluate, diagnose, and treat pain and other SCD complications).


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!