Management of Refractory Pain in Hospitalized Adolescents With Sickle Cell Disease

New, Tamara; Venable, Claudia; Fraser, Laura; Rosenberg, Erin; Schmidt, Jennifer; James-Herry, Anne; Osunkwo, Ifeyinwa; Dampier, Carlton

doi:10.1097/mph.0000000000000026

Cited by 11 publications

(12 citation statements)

References 12 publications

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“…Studies have demonstrated reduced pain and opioid utiliza-tion in individuals who received adjuvant ketamine infusions 6 or regional anesthesia (ie, epidural). 7 Feasibility, however, is limited to centers that have the appropriate experience and expertise with these interventions. Recommendation 5.…”

Section: Key Recommendations For the Hospitalist Acute Painmentioning

confidence: 99%

Clinical Guideline Highlights for the Hospitalist: Management of Acute and Chronic Pain in Sickle Cell Disease

Pham

Hua

2021

Journal of Hospital Medicine

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GUIDELINE TITLE: American Society of Hematology 2020 Guidelines for Sickle Cell Disease: Management of Acute and Chronic Pain RELEASE DATE: June 19, 2020 PRIOR VERSION: Not applicable DEVELOPER: American Society of Hematology Guideline Panel on Sickle Cell Disease-Related Pain FUNDING SOURCE: American Society of Hematology TARGET POPULATION: Adult and pediatric patients with a history of sickle cell disease with acute and chronic pain.

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Section: Key Recommendations For the Hospitalist Acute Painmentioning

confidence: 99%

Clinical Guideline Highlights for the Hospitalist: Management of Acute and Chronic Pain in Sickle Cell Disease

Pham

Hua

2021

Journal of Hospital Medicine

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“…Therefore, PES at a sensory threshold associated with anodic tDCS produces a summing analgesic effect. For example, Boggio 15 experienced a decrease in pain intensity by 36.5% with the two techniques' union, when tDCS alone resulted in only a 15% decrease in pain.…”

Section: Introduction: Background and Rationalesmentioning

confidence: 99%

“…Studies show that tDCS alone has a moderate (20-40%) effect on pain control 14 ; however, it has been proposed as an association of techniques to increase this effect 15 . These therapeutic associations assume that brain responsiveness to a particular therapy can be facilitated by another that alters cortical excitability.…”

Section: Introduction: Background and Rationalesmentioning

confidence: 99%

The immediate effect of transcranial direct current stimulation combined with peripheral electrical stimulation in the control of temporomandibular pain in subjects with sickle cell disease: A protocol for one session randomized, crossover, double-blind clinical trial

et al. 2021

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INTRODUCTION: Temporomandibular disorder (TMD) is currently considered a central sensitization syndrome that belongs to the orofacial nociplastic pain group and offers great challenges for clinical practice. It can also be identified in individuals with sickle cell disease. Neuromodulation is a promising therapy that can help individuals with refractory chronic pain. To our knowledge, there is no treatment proposal for these individuals with chronic orofacial pain resulting from sickle cell disease. OBJECTIVE: This is a protocol of a randomized, double-blind, cross-over clinical trial. The purpose of this protocol is to investigate whether the immediate effect of transcranial direct current stimulation can be increased by adding the effect of peripheral sensory electrical stimulation. METHODS: Twenty women between 18 and 49 years of age will be screened to participate in this cross-over study where they will all receive the three types of protocol with a one-week washout. Active transcranial Direct Current Stimulation (tDCS) + active Peripheral Electrical Stimulation (PES); Active tDCS + PES sham and tDCS sham + PES sham. Stimulation with tDCS will be at 2 mA anodic over the motor cortex for 20 minutes ipsilateral to the most painful temporomandibular joint (TMJ). Peripheral electrical stimulation will be at 100 Hz over the most painful TMJ masseter muscle for 30 min. OUTCOME: The main outcome will be pain intensity assessed by VAS scale and by a pressure algometer in grams. In addition, endogenous pain modulation will be analyzed through the temporal summation of pain with Aesthesio precision tactile sensory filaments and conditioned pain modulation (CPM) evaluated by an algometer and thermal conditioned stimulus, as secondary outcomes. Data will be analyzed using ANOVA of repeated measures, controlling for confounding variables.

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“…9 Thoracic epidural analgesia has been successfully used for SCD-related pain management in acute chest syndrome (ACS). 10,11 However, the use of CPNB for extremity VOCs in this patient population has only been described in a few case reports. 12,13 This is the first case series to highlight uniform CPNB pain management for three patients with upper-extremity VOCs.…”

Section: Introductionmentioning

confidence: 99%

Regional anesthesia for sickle cell disease vaso‐occlusive crisis: A single‐center case series

Karsenty

Tubman

Liu

et al. 2022

Pediatric Blood & Cancer

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Pain management is challenging for patients with sickle cell disease (SCD) who present in vaso‐occlusive crisis (VOC). Opioid therapy is highly effective, nevertheless undesirable side effects can hinder their effectiveness. Regional anesthesia with deposition of perineural anesthetic offers nociceptive blockade, local vasodilatation, and reduces the inflammatory response. Among pediatric patients, continuous peripheral nerve block (CPNB) for perioperative adjunctive analgesia is safe. Herein, we describe the trajectory of a cohort of pediatric SCD patients with opioid‐refractory upper‐extremity VOC following placement of CPNBs for analgesia; highlighting reduced opioid consumption, improved pain scores, and decreased length of hospitalization.

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Management of Refractory Pain in Hospitalized Adolescents With Sickle Cell Disease

Abstract: Continuous epidural analgesia is an alternative to continuing intravenous opioids in sickle cell disease patients with refractory pain, and may reduce opioid-related side effects and facilitate transition to oral analgesics.

Cited by 11 publications

References 12 publications

Clinical Guideline Highlights for the Hospitalist: Management of Acute and Chronic Pain in Sickle Cell Disease

Clinical Guideline Highlights for the Hospitalist: Management of Acute and Chronic Pain in Sickle Cell Disease

The immediate effect of transcranial direct current stimulation combined with peripheral electrical stimulation in the control of temporomandibular pain in subjects with sickle cell disease: A protocol for one session randomized, crossover, double-blind clinical trial

Regional anesthesia for sickle cell disease vaso‐occlusive crisis: A single‐center case series

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