Sickle cell disease patients and patient-controlled analgesia

Sickle cell disease (SCD) is one of the world's commonest hereditary disorders. Painful episodes are the overriding manifestation. SCD pain is largely opioid-sensitive and, in severe cases, adult patients warranting hospitalization often need parenteral opioids. Pain is essentially subjective and is often best controlled by patients themselves. This study looks at SCD patients' perceptions of self-administering parenteral opioids. Using a mainly multiple-choice questionnaire and a focus group interview, data were gathered from 40 adult SCD patients during hospitalization over a 4-month period. The study was approved by the local research ethics committee and the lead clinicians in both the pain and haematology departments. All patients had past opioid-experience for acute pain. The majority (65%) had previously used PCA diamorphine in addition to other opioids. The findings demonstrate that SCD patients perceive the main benefit of PCA to lie in its potential to restore their control over pain relief while in hospital. Other perceived advantages over nurse-administered analgesia included better analgesia accessibility, quick pain relief and relative independence from staff. Patients identified that realization of PCA's full potential is being limited by ineffective analgesic regimens, analgesic side effects and technical shortcomings. Patients found the main disadvantages of PCA to relate to nursing care issues including restrictions placed upon patients' ability to exercise choice and much reduced direct nurse contact. The implications for nursing practice and management involve addressing these patients' concerns through staff training, improving patient-staff communication, inputting resources and further research.