Diagnosis
- Throughout an acute painful sickle cell episode, regard the patient / carer as an expert in their condition, listen to their views and discuss: previous treatment, planned treatment, their concerns
- Moderate pain: VAS score 4-7
- Severe pain: VAS score >7
Investigation
- Clinically assess: BP; Sats (<95%, offer O2); HR; RR; temperature
Management
Analgesia
- Offer analgesia < 30 mins of presentation with an acute painful sickle cell episode:
- Account for analgesia taken for the current episode before presentation
- Ensure drug, dose and administration route are suitable for the severity of the pain and age
- Refer to the patient’s individual care plan if available
- Opioid bolus to all patients in severe pain OR moderate pain who’ve already had some analgesia
- Offer all patients regular paracetamol and NSAIDs in addition to opioid unless contra-indicated
- Assess the effectiveness of pain relief:
- Every 30 min until satisfactory pain relief achieved using an age-appropriate pain scoring tool
- If severe pain on reassessment, offer a second bolus dose of a strong opioid
- Consider patient-controlled analgesia if repeated bolus doses of strong opioid needed within 2 hrs
- If taking an Opioid offer, and monitor every hour for first 6 hours:
- Laxatives on a regular basis
- Anti-emetics as needed
- Antipruritics as needed
Complications:
- Be aware of the possibility of acute chest syndrome with the following symptoms:
- Abnormal respiratory signs and/or symptoms
- Chest pain
- Fever
- Signs and symptoms of hypoxia: Sats < 95% or an escalating O2 requirement
- Acute stroke
- Aplastic crisis
- Infections
- Osteomyelitis
- Splenic sequestration (trapping of sickles cells)
- Do not use corticosteroids in the management of an uncomplicated acute painful sickle cell episode
- Encourage own coping mechanisms (for example, relaxation techniques) for dealing with acute pain
NICE Source: CG143 Sickle cell disease: managing acute painful episodes in hospital. Summary compiled by Dr D P Sheppard MBBS.
