Pain Management in Sickle Cell Disease

Thomas B. Gregory, PharmD, BCPS

Clinical Lead Pharmacist
Surgery and Corporate Pain Committee Co-chair
Truman Medical Center Hospital Hill
Kansas City, MO

Sickle cell disease is the most prevalent genetic blood disorder, affecting approximately 72,000 patients in the US and nearly 30 million patients worldwide. The disease is associated with pain crises—usually lasting between 7 and 10 days—in the extremities and lower back owing to decreased oxygenated blood-flow and resultant microinfarcts throughout the vasculature. Hydration of the patient is critical to promote blood flow in infracted areas. When treating pain in this patient population, nonsteroidal anti-inflammatory drugs should be used with caution because of disease-mediated effects on kidney microvasculature. Opioids are the cornerstone of pain management in patients with sickle cell disease. Because of the high frequency of sickle cell crises in each patient, physicians must weigh the benefits of opioids against their many side effects and well-documented potential for abuse. Here, Dr. Gregory discusses several pharmacologic and nonpharmacologic treatment options for pain associated with sickle cell disease.

References

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3. McClish DK, Smith WR, Dahman BA, et al. Pain site frequency and location in sickle cell disease: the PiSCES project. Pain. 2009;145(1-2):246-51.

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