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Query: UMLS:C0002895 (sickle cell disease)
 11,747 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The purpose of this study was to measure the pain intensity of children with sickle cell disease during vaso-occlusive episodes (VOEs) and to describe their home pain management techniques. This research was guided by Orem's (1991) Self-Care Deficit Theory of Nursing. The instruments used were the African American Oucher Scale (Denyes & Villarruel, 1990) and a pain diary. The study's convenience sample consisted of 30 4- to 18-year-old children attending the Sickle Cell Center at a large Midwestern children's hospital. At the onset of the VOE, 43% of the children reported intense pain levels, and 60% of the children reported levels comparable to that of someone experiencing minor surgery or injury. Older children tended to report higher levels of pain than younger children. There was no statistically significant difference according to gender. The most frequently used pain management tools were Tylenol with codeine, fluid, and ibuprofen. Other pain management techniques used fairly often included application of heat, sleeping, reading, and exercising. The only differences in pain levels associated with the management techniques used were that children who used heat (dry and/or moist) reported higher pain intensity prior to its application than those who did not. This study shows the importance of using an ethnic-appropriate scale to quantify the children's sickle cell pain, which was found to range from intense to minor in nature. The study also identifies numerous self-care actions that children use to manage their pain at home. The pain intensity experienced during VOEs may become worse with age. Evaluation of children's self-care behaviors during VOEs in the home is important because being able to remain in their normal environment helps convince the children that they have some control over their disease.
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PMID:Pain intensity and home pain management of children with sickle cell disease. 911 14

We present the analgesic management of a 4-year-old child who suffered from severe abdominal and leg pain during his first vaso-occlusive crisis with sickle cell disease, diagnosed as beta/S disease when he was 1 year old. His mother and father were carriers of beta-thalassemia and hemoglobin S, respectively. He had an upper respiratory tract infection in which a vaso-occlusive crisis was precipitated. On admission to hospital, fever, severe abdominal and leg pain were noted. Hemoglobin was 4 g x dl(-1) with accompanying prominent reticulocytosis and acute spleen enlargement. These findings indicated a sequestration crisis as well as vaso-occlusive disease. He was transfused with packed red cells. Paracetamol (40-60 mg x kg(-1) x day(-1)) and ibuprofen (20 mg x kg(-1) x day(-1)) were administered to relieve pain. The child experienced moderate to severe pain (Oucher score 60-80) despite nonopioid analgesics, so a tramadol infusion (0.25 mg x kg(-1) x h(-1)) was started. During the tramadol infusion no morphine was required, the intensity of pain gradually decreased (Oucher score 20) and the child was able to move his legs. At the end of 3 days splenomegaly regressed, no fever and pain were observed and the infusion was stopped. In conclusion, tramadol infusion i.v. (0.25 mg x kg(-1) x h(-1)) combined with nonopioids was effective to relieve moderate to severe pain due to vaso-occlusive crisis and can be recommended before using morphine in a pediatric sickle cell crisis.
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PMID:Tramadol infusion for the pain management in sickle cell disease: a case report. 1718 40

While pain is one of the most debilitating symptoms of sickle cell disease, narcotics remain an effective although controversial widely practiced intervention. Vaso-occlusive crises are the most common cause for seeking pharmacological treatment. The influence of stigmatization and pseudo addiction in emergency departments and outpatient clinics was reviewed. We analyzed patterns of narcotic utilization in a sample of 63 adult patients with sickle cell disease to determine if their psychological functioning and reports of pain differed as a function of the primary narcotics they were taking for oral pain management. Fifty-one percent of patients reported treatment of Oxycodone, 35% OxyContin, 24% methadone and 11% morphine. Patients who were treated with Oxycodone reported greater sensory reactions to pain (p = 0.001), visual analog scale (VAS) (p = 0.02), and averaged weekly pain intensity ratings than patients who did not use this medication. There were no differences in pain or affective response in patients treated with OxyContin, methadone or morphine. We suggest there are clear differences between the reports of pain in patients with sickle cell disease taking short-acting narcotics for pain management as compared to those who are not, a pattern that does not distinguish patients who are managed with long-acting preparations. We discuss the relevance of addressing narcotic management in the context of the perception of health care providers and patients with sickle cell disease.
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PMID:Opioid management and dependency among adult patients with sickle cell disease. 2191 Jun 5