Pain management in adult acute sickle cell pain crisis: a viewpoint

The acute pain crisis of sickle cell disease is inadequately treated in many countries.

To present a simple protocol that controls acute pain in most adult patients within 72 hours, based on our experience in an area where sickle cell disease is highly prevalent.

Patients aged 14 years and above with sickle cell disease presenting with pain crisis are treated initially in the Emergency Room. Those responding adequately are discharged home on oral analgesics while those with persisting pain after 6 hours are treated further, for up to 72 hours, in an Observation Unit attached to the Emergency Room. Narcotic analgesics are administered regularly for the first 24 hours.

Using this protocol, acute pain crisis could be terminated or controlled in over 80% of patients within 72 hours.

Regular intravenous narcotic analgesia for the initial 24 hours, supplemented by oral analgesia, is useful for adult patients with severe acute sickle cell pain crisis when the pain is inadequately controlled by initial Emergency Room treatment. There may be gender differences in pain perception and response in acute sickle cell pain crisis.