COMMENTARYThe Sickle Cell Crisis: A Dilemma in Pain Relief
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Addiction vs Pseudoaddiction
Addiction is a chronic neurobiological disorder, the presentation and evolution of which are affected by genetic, psychological, and social components. It is characterized by an impaired ability to control drug use and continued use despite recurrent problems related to self-administration.10, 18, 19, 20 The incentive-sensitization theory of addiction postulates that craving and relapse are drug-induced neuroadaptations that cause stimuli and their re-presentations to become highly salient or
The Race Issue
Patients with sickle cell anemia could suffer disproportionately from recurrent painful episodes with inconsistent and inadequate pain control because of socioeconomic factors associated with their minority status.12, 32, 33, 34 In a national study by Tamayo-Sarver et al35 of emergency department visits, disparities in the treatment of migraine headaches, nontraumatic back pain, and ankle fractures with opiate analgesics were associated with patient race and ethnicity. More specifically,
The Therapeutic Dilemma
A patient with sickle cell anemia who presents with a vasoocclusive crisis exemplifies a quandary in pain management: the obligation to relieve suffering without enabling addiction. The most prevalent malady in the emergency department is pain,45 yet patients with sickle cell anemia who have persistent or recurrent pain that is controlled with opiate analgesics represent a unique challenge.15, 46 In almost all painful conditions, the correlation between objective abnormalities seen on
Implications
Sickle cell anemia is a well-described, genetically determined hemoglobinopathy. Its painful crises are thought to result from transient episodes of microvascular congestion, tissue ischemia, and the release of inflammatory mediators. The pain associated with such episodes can be excruciating. Addiction is a complex, multifactorial illness that emanates from pathophysiologic adaptations in the dopaminergic pathways of the brain after excessive use of the substance.
Sickle cell crises are
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Cited by (32)
If you Can't Assess It, How Can you Treat It? Improving Pain Management in Sickle Cell Disease
2021, Journal of Emergency NursingPerinatal and Neonatal Implications of Sickle Cell Disease
2017, Nursing for Women's HealthCitation Excerpt :Chronic undertreated pain can cause physical and psychological dysfunction, including sleep disturbances and loss of appetite and libido (Gellar & O’Connor, 2008). In cases of severe pain, opioid analgesics are recommended by the American Academy of Pain Medicine, the American Pain Society, and the National Heart, Lung, and Blood Institute (Gellar & O’Connor, 2008; Matthie & Jenerette, 2015). Sustained-release opioid preparations can be used, or relief can be achieved with patient-controlled analgesia.
Sickle Cell Disease in the Emergency Department
2017, Hematology/Oncology Clinics of North AmericaCitation Excerpt :Key goals include prioritization of these patients in triage, early and adequate analgesia,6,27,28 and frequent repeat dosing until pain is controlled.3 EDs should consider implementing patient-controlled analgesia (PCA) programs.3,5,21,22,29–35 The intramuscular route should be avoided in favor of the intravenous, subcutaneous or oral routes,3,29,36 and fluids should be used only in patients who are suspected to be hypovolemic.
Improving Emergency Providers' Attitudes Toward Sickle Cell Patients in Pain
2016, Journal of Pain and Symptom ManagementCitation Excerpt :Requirement of higher doses and requests for particular treatment regimens that are most effective for them can lead health professionals to perceive this as “drug-seeking behavior.” These suspicions are potentially exacerbated by the fact that the disease primarily affects young African Americans, a group that is already perceived by clinicians to have higher rates of substance abuse.3 Clinician characteristics also may affect attitudes.
Pain Management
2016, Smith's Anesthesia for Infants and Children, Ninth EditionMotivations of women with sickle cell disease for asking their partners to undergo genetic testing
2015, Social Science and MedicineCitation Excerpt :Opioids are one of the primary treatments for SCD pain. Unfortunately, this method of treatment provokes providers' suspicion of illegitimate claims of pain and drug-seeking behavior among SCD patients (Geller and O'Connor, 2008). Life expectancy among this population has improved dramatically due to early diagnosis, improvements in comprehensive treatment, and the use of antibiotics (Barakat et al., 2009; Driscoll, 2007).