Nursing Research: Pain in Sickle Cell

For a child with sickle cell disease (SCD), an acute vaso-occlusive episode can be extremely painful, often requiring admission to a hospital. Current guidelines call for aggressive pain management for SCD in the first 2 to 3 days of hospitalization, but there is little standardization in the types of analgesics used, routes of administration, and dosing schedules. Researchers followed 27 children admitted to a hospital in acute pain related to SCD. The children averaged 14 years of age, and 59% were male. On admission and once each subsequent day, the children were asked to complete a pain assessment tool and to rate their levels of worst, least, and current pain on a numerical scale from 1 to 100. The average initial pain rating was 84. The research team reviewed the nursing flowsheets to determine the frequency, dose, and route of administration of all analgesic medications given. Medication usage was evaluated with a modified Medication Quantification Scale (MQS) as a way to account for the different types of pain medications used with hospitalized SCD children and to standardize medications and dose equivalents in a pediatric population.

On the day of admission, the most frequent medications given were morphine, ketorolac, and diphenhydramine, while other medications included acetaminophen, acetaminophen with codeine, amitriptyline, and hydromorphone. The administered doses of morphine were in the subtherapeutic to low therapeutic range in 85% of the cases. Doses of the other medications tended to be in the low therapeutic range. The average MQS score of medications prescribed on the first day of admission was 22, but the average score of the medications actually administered was 16, indicating suboptimal pain treatment despite high initial levels of pain intensity. Both the MQS scores and the pain scores decreased each day, and the average length of stay was 4 to 5 days. These findings indicate that the administered doses of pain medications are often subtherapeutic for children with SCD during an acute vaso-occlusive episode.

Children in Pain From Sickle Cell Disease May Not Receive Adequate Pain Relief
Jacob E, Miaskowski C, Savedra M, Beyer JE, Treadwell M, Styles L. Quantification of analgesic use in children with sickle cell disease. Clinical Journal of Pain. 2007;23:8-14.