Treatment of Sickle Cell Pain

Karen F. Marlowe, PharmD., Michael F. Chicella, PharmD.

Disclosures

Pharmacotherapy. 2002;22(4) 

In This Article

Conclusions

Acute and chronic sickle cell pain present many therapeutic challenges. Specific knowledge of the disease state, altered pharmacokinetics of opiates, and adjunctive therapies allow clinicians to improve treatment of their patients' pain. Institutions serving patients with sickle cell disease would be well advised to develop a protocol for acute management of these patients. Centers with many such patients should evaluate the feasibility of treatment through clinics. Algorithms must address choice of analgesic and route, hydration, and administration of nonsteroidal antiinflammatory drugs. Many effective alternatives for pain control are available for management of sickle cell pain.

Studies describing pharmacotherapy for sickle cell pain have been primarily retrospective and uncontrolled; only a few have compared opiates, and very little difference in their efficacy and safety has been reported. However, meperidine should be avoided if possible, considering its altered pharmacokinetics and the risk of associated adverse effects. A protocol-guided approach to acute pain crises consistently has improved patients' satisfaction with their care. Those with frequent hospital admissions may benefit from a pain-behavior contract to promote more consistent care. Clinicians must manage acute and chronic sickle cell pain aggressively to improve their patients' quality of life.

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