Pain Experience of Children with Sickle Cell Disease Who Had Prolonged Hospitalizations for Acute Painful Episodes

Abstract

PURPOSE.: Vaso-occlusive episodes account for 79-91% of emergency room visits and 59-68% of hospitalizations in patients with sickle cell disease (SCD). There is a growing recognition that acute painful experiences can lead to long-term consequences. The purpose of this study was to examine pain management in children who had prolonged (>10 days) hospitalizations for acute painful episodes. Medical records were reviewed to examine: 1) pain intensity ratings; 2) patterns of analgesic use and patient controlled analgesia (PCA) regimen; and 3) differences in pain intensity and pain management between short (< or =10 days) and prolonged (>10 days) hospitalizations for acute painful episodes. The children reported high pain intensity ratings, which continued throughout hospitalization. The most frequently used medications were morphine delivered using PCA, long-acting morphine, and ketorolac. The total mean amount of morphine administered was 1.16 +/- 0.84 mg/kg/day. The loading and basal rates were administered at doses within the lower range of recommendation. The amount of morphine used was significantly higher during prolonged hospital stays (>10 days) vs short hospital stays (< or =10 days). However, even though the total amount administered was significantly higher during the prolonged (>10 days) hospital stays, the maximum administered amount was on the average only 37% of the prescribed amount on any given day. Pain intensity ratings were persistently reported at high to moderate levels. Research is needed to investigate pain management regimens that would lead to optimal relief and minimize the negative consequences associated with painful episodes in children with SCD.