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Objectives: Sickle With Ibuprofen and Morphine (SWIM) trial was designed to assess whether co-administration of ibuprofen (a non-steroidal anti-inflammatory drug) resulted in a reduction of opioid consumption delivered by patient-controlled analgesia (PCA) for acute pain in sickle cell disease., Design: A randomised, placebo-controlled, double-blind trial., Setting: UK multicentre trial in acute hospital setting., Participants: Adults with sickle cell disease of any gender and phenotype aged 16 years and over., Interventions: Oral ibuprofen at a dose of 800 mg three times daily or placebo in addition to opioids (morphine or diamorphine) administered via PCA pump for up to 4 days., Main Outcome Measures: The primary outcome measure was opioid consumption over 4 days following randomisation., Results: The SWIM trial closed early because it failed to randomise to its target of 316 patients within a reasonable time., Conclusions: The key issues identified include the unanticipated length of time between informed consent and randomisation, difficulties in randomisation of patients in busy emergency departments, availability of trained staff at weekends and out of hours, fewer centres than expected using PCA routinely for sickle cell pain treatment, lack of research staff and support for participation, and the trial design. There are implications for future UK trials in sickle cell disease., Trial Registration Number: ISRCTN97241637, NCT00880373; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Patients with sickle cell disease show wide variations in their experience of pain, and in the impact of pain on everyday functioning. This study examined relations between pain, mood, physical activity, and medication use in a longitudinal naturalistic self-monitoring study of 21 adult sickle cell patients over 12 months. Results suggest that opioid medication use is related to the impact of pain on daily life. Patients who use opioids more frequently for sickle cell pain show more disruption of their lives, with reduced activity levels and more pessimistic mood.

The acute pain crisis (APC) is the commonest complication of sickle cell disease (SCD). Severe episodes may require treatment in hospital with strong opioid analgesic drugs, combined with additional supportive care measures. Guidelines for APC management have been produced over the past two decades gathering evidence from published studies, expert opinion, and patient perspective. Unfortunately, reports from multiple sources indicate that guidelines are often not followed, and that acute care in emergency departments and on acute medical wards is suboptimal. It is important to understand what leads to this breakdown in health care, and to identify evidence-based interventions which could be implemented to improve care. This review focuses on recently published articles as well as information about on-going clinical trials. Aspects of care which could potentially make a difference to patient experience include availability and accessibility of individual care plans agreed between patient and treating specialist, innovative means of delivering initial opioids to reduce time to first analgesia, and availability of a specialist unit away from the ED, where expert care can be delivered in a more compassionate environment. The current evidence of improved outcomes and health economic advantage with these interventions is inadequate, and this is hampering their implementation into health care systems. [ABSTRACT FROM AUTHOR]

Cannabinoids are increasingly being considered for the management of various painful conditions, and could be considered as an option for treating acute pain in sickle cell disease (SCD). The objective of this study was to determine the extent of use of cannabis in the community for pain and other symptom relief, and its side effects during self-administration in patients with SCD. Patients attending Central Middlesex Hospital in London were invited to complete a structured self-administered anonymous questionnaire. Eighty-six young adults with HbSS, HbSC and HbS βthalassaemia disease (median age 30 years) participated in the study. Results showed that 31 (36%) had used cannabis in the previous 12 months to relieve symptoms associated with SCD. The main route in all but two patients was by smoking. The main reasons for use were to reduce pain in 52%, and to induce relaxation or relieve anxiety and depression in 39%. Symptoms related to sedation and mood effects were reported in 77% of patients. The majority of patients (58%) expressed their willingness to participate in studies of cannabis as a medicine. We conclude that research in the use of cannabinoids for pain relief in SCD would be both important and acceptable to adult patients. [ABSTRACT FROM AUTHOR]

Objective. To examine the relationship between pain, coping, and quality of life in adult patients with sickle cell disease (SCD) in the UK, and to assess the influence of these factors on the utilization of health services. Design, This cross-sectional study involved 96 adult patients with SCD attending hospitals in London. Method. Interview and questionnaire study involving standard measures of pain, health service utilization, coping responses (measured with the Coping Strategies Questionnaire -- revised for SCD), and quality of life (measured by the SF36). Data concerning clinical history, complications and haemoglobin levels were also collected. Results. The number and duration of painful sickle cell episodes in the past 12 months varied widely between patients. We found that 49.5% of accident and emergency visits and 45% of hospitalizations were of 10.4% (10) patients. Pain experience accounted for 12.3% of hospital and general practice service use, independently of age, sex, number of SCD complications and haemoglobin levels. Three higher order factors emerged from analysis of the coping strategies questionnaire, reflecting active behavioural and cognitive coping, affecting coping, and passive adherence (e.g. resting, taking fluids). Active coping was positively associated with the number of pain episodes, while passive adherence coping was related to pain intensity. Psychological coping was unrelated to health service utilization. Marked impairment on many dimensions of quality of life was apparent in the analyses of the SF36. Affective coping was associated with impaired quality of life independently of demographic and clinical variables. Conclusions, It is evident that siclde cell disease involves not only severe recurrent pain, but also other impairments in health-related quality of life. Psychological coping patterns... [ABSTRACT FROM AUTHOR]