Evaluation of acute pain in sickle cell disease
- Michael R DeBaun, MD, MPH
Michael R DeBaun, MD, MPH
- Professor of Pediatrics and Internal Medicine
- Vanderbilt University School of Medicine
- Elliott P Vichinsky, MD
Elliott P Vichinsky, MD
- Adjunct Professor
- University of California San Francisco
- Section Editors
- Donald H Mahoney, Jr, MD
Donald H Mahoney, Jr, MD
- Section Editor — Pediatric Hematology
- Professor of Pediatrics
- Baylor College of Medicine
- Stanley L Schrier, MD
Stanley L Schrier, MD
- Editor-in-Chief — Hematology
- Section Editor — Myeloproliferative Disorders; Red Blood Cell Disorders
- Professor of Medicine
- Stanford University School of Medicine
Acute painful episodes are likely to be the most common reason for individuals with sickle cell disease (SCD) to seek medical attention.
When a patient with SCD presents with pain, the evaluation (to characterize the pain and uncover any associated conditions) and the treatment for the pain (analgesia and other interventions) both need to occur rapidly. A major aspect of the evaluation involves distinguishing between pain due to vaso-occlusion and pain that signifies more serious complications of disease, which often require separate evaluations and treatments in addition to analgesia.
This topic review discusses the immediate evaluation of the individual with SCD who presents with acute pain, and the testing needed to identify other SCD complications or comorbidities that require treatment.
Separate topic reviews provide detailed discussions of our approaches to providing analgesia for acute vaso-occlusive pain, chronic SCD pain management, and the role of blood transfusion in treating acute SCD complications such as stroke, acute chest syndrome, and multiorgan failure.
●Analgesia for acute pain – (See "Vaso-occlusive pain management in sickle cell disease", section on 'Acute pain management'.)
- American Pain Society. Guideline for the management of acute and chronic pain in sickle cell disease. 1999.
- Zempsky WT. Evaluation and Treatment of Sickle Cell Pain in the Emergency Department: Paths to a Better Future. Clin Pediatr Emerg Med 2010; 11:265.
- Chaturvedi S, Ghafuri DL, Glassberg J, et al. Rapidly progressive acute chest syndrome in individuals with sickle cell anemia: a distinct acute chest syndrome phenotype. Am J Hematol 2016; 91:1185.
- Anand KJ, Willson DF, Berger J, et al. Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics 2010; 125:e1208.
- CLINICAL ASSESSMENT OF PAIN
- Features associated with vaso-occlusive pain
- Features that suggest an additional complication
- Importance of providing prompt analgesia
- POTENTIALLY SERIOUS CONDITIONS ASSOCIATED WITH PAIN
- Overview of possible conditions and our approach to distinguishing among them
- Acute systemic illness, diffuse pain, or both
- Headache, mental status changes, or both
- Chest pain
- Abdominal pain
- Extremity pain
- ROLE OF BLOOD TRANSFUSION
- SUMMARY AND RECOMMENDATIONS