1. Pain management in sickle cell disease`
Dr Abeera Zareen

2. Types of pain in sickle cell disease
Acute pain
Chronic pain

3. Acute pain in sickle cell disease
Acute pain is vasoocclusive pain which develops when sickle shaped red blood cells block blood flow through tiny blood vessels to chest , abdomen , and joints. Vaso occlusive crisis also known as sickle cell crisis is the hallmark symptom of the disease.

4. Common sites of pain include bone extremities ,hand /foot syndrome ,back and abdominal pain.
For all degrees of pain( mild,moderate and severe)
Acetoaminophen and ibuprofen are recommended unless contraindication exist.
For moderate pain (4-6 on numerical scale ) Morphine or Hydromorphone can be taken orally or IV.

5. IV is preferred if oral management at an adequate dose has failed or if within minutes pain relief is inadequate on oral Opioids.
If adequate pain relief is established for two hours with 1 or 2 doses of IV Opioid change to equivalent dose of oral Opioid.
For severe pain(greater then7 on numerical rating scale) proceed to morphine infusion or Hydromorphone continuous IV infusion.

6. Chronic pain in sickle cell disease
Chronic pain is not always simply a continuation of pain of vaso occlusion ,it is usually secondary to avascular necrosis of bone at various joints like hips, shoulders etc

7. Treatment of chronic pain in sickle cell disease
The approach for management of chronic pain is multimodal including the use of analgesic drugs dicussed earlier , nerve blocks , physiotherapy , orthopedic intervention or surgery .

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