Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management
Samuel N Uwaezuoke,1 Adaeze C Ayuk,1 Ikenna K Ndu,2 Chizoma I Eneh,2 Ngozi R Mbanefo,1 Osita U Ezenwosu1 1Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: This narrative...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2018-12-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/vaso-occlusive-crisis-in-sickle-cell-disease-current-paradigm-on-pain--peer-reviewed-article-JPR |
| _version_ | 1831702947467100160 |
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| author | Uwaezuoke SN Ayuk AC Ndu IK Eneh CI Mbanefo NR Ezenwosu OU |
| author_facet | Uwaezuoke SN Ayuk AC Ndu IK Eneh CI Mbanefo NR Ezenwosu OU |
| author_sort | Uwaezuoke SN |
| collection | DOAJ |
| description | Samuel N Uwaezuoke,1 Adaeze C Ayuk,1 Ikenna K Ndu,2 Chizoma I Eneh,2 Ngozi R Mbanefo,1 Osita U Ezenwosu1 1Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain.Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants – either singly or in combination – depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia. Keywords: sickle cell pain, nociceptive pain, non-opioids, opioids, multimodal analgesia, cognitive behavioral therapy |
| first_indexed | 2024-12-20T15:31:05Z |
| format | Article |
| id | doaj.art-b4bc8b546954424382699811ad33f582 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-20T15:31:05Z |
| publishDate | 2018-12-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-b4bc8b546954424382699811ad33f5822022-12-21T19:35:36ZengDove Medical PressJournal of Pain Research1178-70902018-12-01Volume 113141315042948Vaso-occlusive crisis in sickle cell disease: current paradigm on pain managementUwaezuoke SNAyuk ACNdu IKEneh CIMbanefo NREzenwosu OUSamuel N Uwaezuoke,1 Adaeze C Ayuk,1 Ikenna K Ndu,2 Chizoma I Eneh,2 Ngozi R Mbanefo,1 Osita U Ezenwosu1 1Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria; 2Department of Pediatrics, Enugu State University Teaching Hospital, Enugu, Nigeria Abstract: This narrative review aims to highlight the current paradigm on pain management in sickle cell vaso-occlusive crisis. It specifically examines the pathophysiologic mechanisms of sickle cell pain as well as the pharmacologic and nonpharmacologic methods of pain management. Recurrent painful episodes constitute the major morbidity in sickle cell disease (SCD). While adolescents and young adults experience mostly acute episodic nociceptive pain, it is now recognized that a significant number of adult patients develop chronic neuropathic and centralized pain. In fact, current evidence points to an age-dependent increase in the frequency of SCD patients with chronic pain.Management of disease-related pain should be based on its pathophysiologic mechanisms instead of using recommendations from other non-SCD pain syndromes. Pain management in vaso-occlusive crisis is complex and requires multiple interventions such as pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment involves the use of non-opioid and opioid analgesics, and adjuvants – either singly or in combination – depending on the severity of pain. The basic approach is to treat SCD pain symptomatically with escalating doses of non-opioid and opioid analgesics. Given the moderate-to-severe nature of the pain usually experienced in this form of SCD crisis, opioids form the bedrock of pharmacologic treatment. Multimodal analgesia and structured, individualized analgesic regimen appear more effective in achieving better treatment outcomes. Although the current evidence is still limited on the supportive role of cognitive behavioral therapy in pain management, this nonpharmacologic approach is reportedly effective, but needs further exploration as a possible adjunct in analgesia. Keywords: sickle cell pain, nociceptive pain, non-opioids, opioids, multimodal analgesia, cognitive behavioral therapyhttps://www.dovepress.com/vaso-occlusive-crisis-in-sickle-cell-disease-current-paradigm-on-pain--peer-reviewed-article-JPRSickle cell painnociceptive painnon-opioidsopioidsmultimodal analgesiacognitive behavioral therapy |
| spellingShingle | Uwaezuoke SN Ayuk AC Ndu IK Eneh CI Mbanefo NR Ezenwosu OU Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management Journal of Pain Research Sickle cell pain nociceptive pain non-opioids opioids multimodal analgesia cognitive behavioral therapy |
| title | Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management |
| title_full | Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management |
| title_fullStr | Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management |
| title_full_unstemmed | Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management |
| title_short | Vaso-occlusive crisis in sickle cell disease: current paradigm on pain management |
| title_sort | vaso occlusive crisis in sickle cell disease current paradigm on pain management |
| topic | Sickle cell pain nociceptive pain non-opioids opioids multimodal analgesia cognitive behavioral therapy |
| url | https://www.dovepress.com/vaso-occlusive-crisis-in-sickle-cell-disease-current-paradigm-on-pain--peer-reviewed-article-JPR |
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