The Use of Analgesic Drugs in Patients with Sickle Cell Painful Crisis

OBJECTIVE To determine the drug options used for pain in patients with acute sickle cell painful crisis at the University Hospital of the West Indies (UHWI), Jamaica. METHOD This retrospective study assessed all patients admitted to the UHWI between January 1, 2006 and December 31, 2010 with acute sickle cell anaemia painful crisis and the data obtained regarding site, severity, outcome and drug options selected for pain. RESULTS There were 101 patients with a mean age (± SD) of 18.6 (± 14.3) years; there was no difference in gender (42 females, 59 males). Eight sites of pain were reported, with the most common site being the lower limbs (44.6%) and 60.3% experienced pain in more than one site. Most of the patients (75.2%) were diagnosed with severe pain. Drug options included opioid, non-opioid or a combination, with pethidine (76) and paracetamol (79) being the most common chosen opioid and non-opioid drugs selected for therapy. There was low correlation between pain severity and appropriate first-line treatment (Spearman's rho = 0.344; p < 0.000). All patients with "mild" and "mild to moderate" pain were initially treated and obtained resolution of pain with non-opioid based therapy. However, most of the patients with severe pain (55.3%) required a second-line and some third-line (14.5%) of therapy for resolution at the time of discharge from the hospital. CONCLUSION Painful crisis in patients with sickle cell anaemia is associated with severe pain in 75% and most will require second-line therapy for adequate resolution. Physicians need to provide adequate pain relief to decrease morbidity in these patients.