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Management of vaso-occlusive pain in children with sickle cell disease
Eufemia Jacob1, Christine Miaskowski, Marilyn Savedra
1Department of Hematology/Oncology, Texas Children's Cancer Center, Houston, Texas 77030, USA. exjacob@txccc.org
Insights
Children with sickle cell disease often receive insufficient pain relief from patient-controlled analgesia (PCA). Effective pain management requires closer monitoring of analgesic delivery and titration for optimal pain control.
Area of Science:
- Pediatric Hematology
- Pain Management
- Sickle Cell Disease
Background:
- Sickle cell disease (SCD) is a genetic disorder causing severe pain episodes.
- Effective pain management is crucial for children experiencing vaso-occlusive episodes (VOEs).
Purpose of the Study:
- To evaluate pain management strategies in pediatric SCD patients during VOEs.
- To assess the effectiveness of patient-controlled analgesia (PCA) in managing SCD pain.
Main Methods:
- A longitudinal, descriptive study design.
- Medication administration data and patient-reported pain relief scores were collected during hospitalization.
- Pain relief was rated on a 0-10 scale by children daily.
Main Results:
- Children self-administered only 35% of prescribed analgesics via PCA.
- Reported pain relief was minimal, with no correlation between administered analgesics and pain relief scores.
- PCA effectiveness in managing SCD pain was limited.
Conclusions:
- Current PCA regimens may not adequately control pain in pediatric SCD patients.
- Clinicians must monitor analgesic delivery, assist with PCA titration, or adjust regimens when necessary.
- Improved strategies are needed to ensure optimal pain control for children with SCD.
Purpose:
A descriptive, longitudinal design was used to evaluate the pain management strategies used in children with sickle cell disease who were experiencing pain during a vaso-occlusive episode.
Methods:
A list of the medications (name, amount, mode of delivery, and frequency) prescribed and administered for pain management for each participant was recorded on the Medication Quantification Scale Worksheet, starting from day 1 of hospitalization to the day of discharge. Children were asked once each evening to provide three separate ratings of how much the pain medication helped them during the day, evening, and night using a 0-to-10 rating scale.
Results:
Using patient-controlled analgesia (PCA), children self-administered only 35% of the analgesic medications that were prescribed and reported little pain relief. No significant relationships were found between changes in pain relief scores and the amount of analgesics administered.
Conclusions:
Clinicians need to monitor the amount of analgesics delivered in relationship to pain relief and assist children to titrate PCA administration of analgesics to achieve optimal pain control, or to advocate for changes in the PCA regimen when children cannot assume control of pain management.
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