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Published on: March 14, 2017
Inpatient Management of Pain Episodes in Children with Sickle Cell Disease: A Review
Zhour Barnawi1,2, Ronay Thomas3, Radhika Peddinti1
1Department of Pediatrics, Section of Hematology-Oncology and Bone Marrow Transplant, University of Chicago Medicine, Chicago, IL 60637, USA.
Insights
Sickle cell disease (SCD) patients experience severe pain during vaso-occlusive episodes (VOEs). This review outlines best practices for managing inpatient SCD pain using multimodal approaches and equitable care strategies.
Area of Science:
- Hematology
- Pain Management
- Health Equity
Background:
- Sickle cell disease (SCD) is the most prevalent hemoglobinopathy globally.
- Vaso-occlusive episodes (VOEs) are the primary cause of hospitalization and severe pain in SCD patients.
- Historical and systemic biases impact pain management for SCD patients.
Purpose of the Study:
- To outline best practices for managing SCD-related vaso-occlusive episodes (VOEs) during inpatient hospitalizations.
- To emphasize a holistic and equitable approach to pain management in SCD.
- To advocate for systematic and individualized pain management strategies.
Main Methods:
- Review of current literature and clinical guidelines for SCD pain management.
- Discussion of multimodal pharmacologic and non-pharmacologic treatment strategies.
- Emphasis on integrating functional pain assessment into care plans.
Main Results:
- Effective inpatient SCD pain management requires a systematic, multimodal approach.
- Addressing structural racism and implicit bias is crucial for equitable care.
- Standardized and individualized pain plans improve patient outcomes.
Conclusions:
- Comprehensive pain management for SCD VOEs involves combining medication, non-pharmacologic therapies, and functional assessments.
- Implementing system-wide standardized pain plans alongside individualized patient care is essential for equity.
- This approach aims to reduce pain and improve functional outcomes for hospitalized SCD patients.
Abstract:
Sickle cell disease (SCD) is the most common hemoglobinopathy in the world. Sickle cell vaso-occlusive episodes (VOEs) are very painful acute events and the most common complication as well as reason for hospitalization. SCD pain is best evaluated holistically with a pain functional assessment to aid in focusing pain management on reducing pain in addition to improving function. Patients with SCD have long endured structural racism and negative implicit bias surrounding the management of pain. Thus, it is important to approach the management of inpatient pain systematically with the use of multi-modal medications and nonpharmacologic treatments. Furthermore, equitable pain management care can be better achieved with standardized pain plans for an entire system and individualized pain plans for patients who fall outside the scope of the standardized pain plans. In this article, we discuss the best practices to manage SCD VOEs during an inpatient hospitalization.
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