Pain management for sickle cell disease in children and adults

Dunlop, Robert; Bennett, K C L B

doi:10.1002/14651858.cd003350.pub3

Cited by 16 publications

(15 citation statements)

References 43 publications

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“…Pain episodes or crises may occur unpredictably (Fosdal & Wojner-Alexandrov, 2007) and are the most common reason for hospital visits (Yusuf, Atrash, Grosse, Parker, & Grant, 2010). Adults with SCD average over 197,000 emergency department visits annually; 67% of patients report pain as the reason for the emergency department visit and 29% result in hospital admissions (Yusuf et al), with 90% of the admissions being for the treatment of acute pain (Dunlop & Bennett, 2009). Management of this chronic disease occurs primarily at home and includes a strong emphasis on self-care across the lifespan.…”

Section: Introductionmentioning

confidence: 99%

Role of Self-Care in Sickle Cell Disease

Matthie

Jenerette

McMillan

2015

Pain Management Nursing

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Background Self-care is an important aspect of managing a chronic disease. In sickle cell disease (SCD), home self-care contributes to individual pain management and thus pain crisis prevention. A better understanding of self-care can help health care providers equip patients with the resources and skills necessary to participate in their disease management. Aims To examine factors which influence self-care among young adults with SCD. Design A descriptive, cross-sectional study was conducted using secondary data analysis. Settings Participants were recruited from two SCD clinics in the southeastern United States. Participants The sample consisted of 103 young adults, ages 18–30 years, with SCD. Methods Bivariate correlations and regression analyses were used to evaluate the relationships among SCD self-efficacy, social support, socio-demographics, self-care, and hospital visits for pain crises. Results Study participants were primarily female (61.2%), unemployed or disabled (68%), lived with family (73.8%), and had an average of three hospital visits for pain crises annually. Participants, on average, had 12 years of education, an annual household income of $35,724, and were 24 years old. Social support (p=.001), SCD self-efficacy (p=.002), and years of education (p=.043) were significantly related to self-care. Of the hypothesized variables, only income was significantly associated with hospital visits for pain crises (r=−.219, p=.05). Conclusions Individuals with SCD may benefit from self-care interventions that enhance social support, SCD self-efficacy, and access to education. To inform intervention development, further investigation is needed regarding daily self-care behaviors used by young adults with SCD.

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Section: Introductionmentioning

confidence: 99%

Role of Self-Care in Sickle Cell Disease

Matthie

Jenerette

McMillan

2015

Pain Management Nursing

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“…Large‐scale inpatient therapeutic studies for SCD have historically been difficult to complete . Currently available data are limited, studies often underpowered, and results sometimes difficult to interpret . Poor patient enrollment has been cited as major limitations in most studies .…”

Section: Discussionmentioning

confidence: 99%

“…Despite noteworthy advances in the management of other comorbidities of SCD and significant progress in the understanding of the pathophysiology of VOC , little has changed in the management of acute SCD pain in recent decades. Current management is based primarily on expert opinion , with evidence‐based acute management derived from small, often inadequately powered SCD‐specific studies or studies of non‐SCD pain . Robust multi‐center clinical trials for VOC are few in number and recent attempts have been plagued with multiple challenges leading to poor patient enrollment .…”

Section: Introductionmentioning

confidence: 99%

Intravenous magnesium for pediatric sickle cell vaso‐occlusive crisis: Methodological issues of a randomized controlled trial

Badaki-Makun

Scott

Casper

et al. 2014

Pediatric Blood & Cancer

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Background Multiple recent Sickle Cell Disease studies have been terminated due to poor enrollment. We developed methods to overcome past barriers and utilized these to study the efficacy and safety of intravenous magnesium for vaso-occlusive crisis (VOC). We describe the methods of the Intravenous Magnesium in Sickle Vaso-occlusive Crisis (MAGiC) trial and discuss methods used to overcome past barriers. Procedure MAGiC was a multicenter randomized double-blind placebo-controlled trial of intravenous magnesium versus normal saline for treatment of VOC. The study was a collaboration between Pediatric Hematologists and Emergency Physicians in the Pediatric Emergency Care Applied Research Network (PECARN). Eligible patients were randomized within 12 hours of receiving intravenous opioids in the emergency department (ED) and administered study medication every eight hours. The primary outcome was hospital length of stay. Associated plasma studies elucidated magnesium’s mechanism of action and the pathophysiology of VOC. Health-related quality of life was measured. Site-, protocol- and patient-related barriers to prior studies were identified and addressed. Results Limited study staff availability, lack of collaboration with the ED, and difficulty obtaining consent were previously identified barriers. Leveraging PECARN resources, forging close collaborations between Sickle Cell Centers and EDs of participating sites, and approaching eligible patients for prior consent helped overcome these barriers. Conclusion Participation in the PECARN network and establishment of collaborative arrangements between Sickle Cell Centers and their affiliated EDs are major innovative features of the MAGiC study that allowed improved subject capture. These methods could serve as a model for future studies of VOCs.

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“…These are consistent in recognizing the paucity of clinical trial data, and the need to develop robust guidelines that are regularly audited on a local level. A Cochrane review (Dunlop & Bennett, ) highlighted the need for a standardized protocol of pain management as the basis for a control arm in future randomized controlled trials (RCTs) and recommended standardized measures of pain intensity and pain relief to facilitate comparison between studies. A recent NICE clinical guideline (NICE, ) has noted limited evidence on the effectiveness of different opioid protocols and has recommended conducting RCTs to compare different drugs, formulations and routes of administration.…”

Section: Evidence Base For Apc Managementmentioning

confidence: 99%

“…Admission to hospital with an acute complication is a frequent experience for patients with SCD, and it is important that patients’ views are taken into account in developing a management protocol for APC. The Cochrane Review of pain management suggested it would be useful to develop measures that quantify outcomes of relevance to patients and families (Dunlop & Bennett, ).…”

Section: Patient Experiencesmentioning

confidence: 99%

Management of the acute painful crisis in sickle cell disease‐ a re‐evaluation of the use of opioids in adult patients

Telfer

Bahal

et al. 2014

Br J Haematol

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SummaryManagement of the acute painful crisis (APC) of sickle cell disease (SCD) remains unsatisfactory despite advances in the understanding and management of acute pain in other clinical settings. One reason for this is an unsophisticated approach to the use of opioid analgesics for pain management. This applies to haematologists who are responsible for developing acute sickle pain management protocols for their patients, and to health care staff in the acute care setting. The objective of this article is to evaluate the evidence for use of opioids in APC management. We have highlighted the possibilities for improving management by using alternatives to morphine, and intranasal (IN) or transmucosal routes of administration for rapid onset of analgesia in the emergency department (ED). We suggest how experience gained in managing acute sickle pain in children could be extrapolated to adolescents and young adults. We have also questioned whether patients given strong opioids in the acute setting are being safely monitored and what resources are required to ensure efficacy, safety and patient satisfaction. We also identify aspects of care where there are significant differences of opinion, which require further study by randomized controlled trial.

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Pain management for sickle cell disease in children and adults

Abstract: Pain management for sickle cell disease in children and adults.

Cited by 16 publications

References 43 publications

Role of Self-Care in Sickle Cell Disease

Role of Self-Care in Sickle Cell Disease

Intravenous magnesium for pediatric sickle cell vaso‐occlusive crisis: Methodological issues of a randomized controlled trial

Management of the acute painful crisis in sickle cell disease‐ a re‐evaluation of the use of opioids in adult patients

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