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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A significant number of children with sickle cell disease suffer from episodes of acute recurrent vaso-occlusive pain crisis. Unfortunately, very limited published information is available about specific pain management practices used for these patients. There is even less information available on the use of an interdisciplinary approach for management of sickle cell crisis pain. The purpose of this article is to review the genetic cellular pathophysiology, the sickling process, vaso-occlusive crisis, and management of pain associated with sickle cell disease in children. The article further examines an interdisciplinary approach for the management of vaso-occlusive pain crisis.
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PMID:A holistic approach to vaso-occlusive pain crisis in children with sickle cell disease. 129 5

The effect of oxygen therapy on the number of irreversibly (ISC) and reversibly (RSC) sickled cells was studied in patients with sickle cell anemia. Inhalation of 50% oxygen in patients who were not in crisis produced a significant fall in RSCs and a lesser fall in ISCs. Twenty-five subjects in sickle cell crisis were chosen at random to receive either oxygen (15 patients) or air (10 patients). Those who received oxygen showed a significant reduction in RSCs, but not in ISCs. No significant change in RSCs or ISCs occurred in the group who received air. Despite the reduction in RSCs in the oxygen-treated group, there was no significant difference between the air and oxygen groups in the duration of severe pain, opioid administration, and hospitalization. It was also observed that crisis was associated with arterial desaturation and a reduction in the number of RSCs. We conclude that, although RSCs may be involved in the pathophysiology of sickle cell crisis, reduction in RSCs by oxygen therapy in these studies did not result in any reduction in the duration of crisis.
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PMID:Oxygen therapy in sickle cell disease. 151 Jan 91

Hypnosis has been used as a therapeutic tool for centuries, but only in the past 50 years have the clinical applications been delineated. As evident in the medical literature, the use of hypnosis by the medical community has increased, partly as a result of a growing awareness of hypnotherapy as an available treatment modality, and also as a result of major improvements in research methodology through strict standardization. Hypnotherapy, once considered to be limited to entertainment, has now proven useful in the treatment of a wide variety of medical illness. Two cases of the use of hypnosis are presented. In the first case, hypnosis is used to alleviate pain in a gravid patient in sickle cell crisis. In the second case, hypnosis is used for desensitization of dental phobia in a 27-year-old women. The historical, theoretical, and clinical applications of hypnosis are reviewed.
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PMID:Clinical applications of hypnotherapy. 198 28

The potential danger of low oxygen tension to patients with sickle cell disease is widely known. However, less well known is the phenomenon of patients with sickle cell disease presenting with toothache in the absence of any dental pathology. This study investigated the experience of orofacial pain in three matched groups, comprising patients with sickle cell disease, sickle cell trait and patients with no known blood dyscrasia. There were no differences in pain experience between those groups with sickle cell trait and no known blood dyscrasia. The sickle cell disease patients experienced significantly more orofacial pain in the same 12-month period than the other groups. The pain was also more frequent and of longer duration. In two-thirds of those sickle cell disease patients who experienced toothache, no dental pathology was found, in direct contrast to patients with trait or no known blood dyscrasia. Sickling of blood cells within the dental pulp in a sickle cell crisis may result in pain within teeth. These patients may then present as experiencing toothache in the absence of any dental pathology. General dental practitioners should be aware of this phenomenon when providing care for these susceptible patients.
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PMID:Orofacial pain in patients with sickle cell disease. 220 67

This double-blind study compared the analgesic effects of morphine with those of butorphanol in patients who presented with pain because of sickle cell crisis. Patients were placed at bed rest, administered IV hydration, and randomly assigned on each visit to receive either 2 mg IM butorphanol or 6 mg IM morphine every 30 to 60 minutes as needed to produce a pain intensity of 50 mm or less on the linear analog pain scale until the patient was discharged. Linear analog scale for pain and pain relief, level of alertness, and vital signs were assessed at 60 and 120 minutes after each study drug dose, before additional doses, and at discharge. Eighteen patients (12 men, six women; mean age, 29.3 +/- 7.7 years) were studied. Six received only morphine, six received only butorphanol, and six received each treatment at some time during the study period, resulting in 45 randomizations to treatment. The two therapies did not differ significantly (P greater than .40) with respect to pain or relief of pain scores, level of alertness, or vital signs. The discharge rate was 69.6% and 68.2% with morphine and butorphanol, respectively (P = .92). The incidence of adverse effects was 13% and 23% with morphine and butorphanol, respectively (P = .46). We conclude that morphine and butorphanol are equally effective in the treatment of sickle cell crisis pain.
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PMID:Comparison of intramuscular analgesic activity of butorphanol and morphine in patients with sickle cell disease. 271 77

The use of a constant infusion of intravenous morphine sulfate in a patient with severe sickle cell crisis is described. After several days of poor control with intramuscular and intravenous narcotic injections, adequate analgesia was obtained with the infusion of morphine within two hours of initiation of therapy. No adverse effects were noted. With the advantages provided by an intravenous narcotic infusion, this protocol should be considered as a suitable alternative to conventional methods for providing pain control in patients in sickle cell crisis.
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PMID:Constant morphine infusion for severe sickle cell crisis pain. 360 11

Conflicting results have arisen from studies concerning the correlation (if any) between climatological changes and the frequency of painful episodes in the sickle cell population. During a 13 month period records of 71 patients with hemoglobin genotypes SS or SC were reviewed. Data analysis failed to reveal an association between the frequency of painful sickle cell crisis and a number of weather and environmental variables. We were unable to demonstrate relationships between the climatologic factors of temperature, humidity, carbon monoxide level and precipitation in the frequency of 362 pain crises in 71 sickle cell patients during a 13 month period.
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PMID:Non relationship of climatologic factors and painful sickle cell anemia crisis. 394 23

This study was designed to measure the degree of association between dental pain and its frequency during sickle cell crisis. Randomized study and control groups, each consisting of outpatient clinic patients, were selected. Each subject was interviewed via a questionnaire designed to record information describing immediate and past experiences of dental pain and its characteristics. The results were analyzed statistically. This investigation showed that there is an increase of dental pain, in the apparent absence of specific pathosis, in sickle cell patients during crisis. It was found that 36% of these patients had experienced some significant transitory pain in the oral-maxillofacial complex either alone or as part of the crisis syndrome.
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PMID:A study of oral pain experience in sickle cell patients. 658 76

Acute abdominal pain frequently accompanies sickle cell crisis. The character of this pain may be difficult to discriminate from acute surgical processes such as acute cholecystitis or appendicitis. Seven patients with sickle cell disease presenting with abdominal pain underwent surgery. Review of the medical records demonstrated a characteristic pattern of presentation consistent from crisis to crisis. When patients with known sickle cell disease present with symptoms of abdominal pain, (1) the character of the symptoms, (2) precipitating events, (3) white blood cell count, (4) bilirubin, and (5) fever should be compared with those characteristics in previous crises. Deviation from previous patterns suggests an illness caused by problems other than sickel cell crisis.
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PMID:Acute surgical illness in patients with sickle cell anemia. 725 5

This study sought to provide insights into the personal experiences of individuals with sickle cell disorder and nurses involved in the management of painful sickle cell crisis. The sample consisted of 10 patients who experienced hospitalization for the management of pain during sickle cell crisis and 10 nurses who have cared for patients during such crises. The method of data collection used a combination of group and individual interviews, utilizing a 'guided conversation approach'. Data analysis consisted of content analysis of transcribed interviews which resulted in the identification of the following categories of problems: poor pain management, anxieties about pethidine, loss of control, lack of individuality and playing up. The results revealed that pain control during sickle cell crisis is often inadequate, with nurses admitting that they often have to resort to 'trial and error' strategy to manage pain. The findings are discussed in terms of attitudinal and knowledge factors and an individualized approach to pain management.
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PMID:The management of sickle cell crisis pain as experienced by patients and their carers. 802 94


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