Beyond IV push: alternative methods for management of acute pain in SCD

Abstract

Acute pain in sickle cell disease (SCD) involves multiple, complex downstream effects of vaso-occlusion, ischemia, and inflammation, ultimately resulting in severe and sudden pain. Historically, opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) have been the cornerstone of treatment for acute SCD pain. However, given the evolving understanding of the complexity of pain pathways in SCD and the desire to avoid NSAID and opioid-induced side effects, a multimodal approach is needed to effectively treat acute SCD pain. In this article we review recent research supporting the utilization of nonopioid pharmacologic interventions and nonpharmacologic interventions while also describing the research questions that remain surrounding their use and efficacy and effectiveness in the management of acute SCD pain. Furthermore, we review care delivery processes shown to improve acute SCD pain outcomes and highlight areas where more work is needed. Through this comprehensive approach, alternative mechanistic pathways may be addressed, leading to improved SCD pain outcomes.

Graphical abstract

Figure 1.

Care delivery for acute pain in SCD. Optimizing care delivery practices influences clinical outcomes in acute SCD pain. Patients should have established individualized pain plans detailing the medications and dosing that have previously provided pain relief. Effective and comprehensive individualized pain plans often require multi-isciplinary collaboration with anesthesia/acute pain teams, psychology and/or psychiatry, pharmacy, physical therapy, integrative health, and child life. In the event of acute SCD pain, rapid analgesia (within 60 minutes of arrival) is critical to providing effective pain relief. The use of an individualized pain plan and day hospital/infusion center may facilitate rapid analgesia and avoid potential delays in EDs. Reassessments and repeated analgesia are recommended every 30 to 60 minutes. Ongoing multidisciplinary support for additional pain management and continuous adjustments to the individualized pain plan are needed.