Treating sickle cell pain like cancer pain.

Abstract

OBJECTIVE: To assess the effect of a structured analgesic regimen on hospital use by patients with sickle cell disease. INTERVENTION: Intravenous and oral controlled-release morphine was used instead of intramuscular meperidine and short-acting oral opioids for the treatment of sickle cell pain. DESIGN: Time series in which emergency and admission records for four 6-month periods before and two 6-month periods after the institution of the new analgesic protocol were reviewed. SETTING: Inner-city university hospital providing care for adults with sickle cell disease. PATIENTS: All patients (an average of 50) who used the emergency department of the inpatient medical service for treatment of sickle cell crisis during the study periods. MEASUREMENTS AND MAIN RESULTS: The number of admissions for sickle cell pain decreased by 44%, total inpatient days by 57%, length of hospital stay by 23%, and the number of emergency department visits by 67% after initiation of the morphine protocol. Hospital use remained at these lower levels one year later. Similar declines were seen for a subset of 15 patients who had a history of frequent admissions for sickle cell pain and who used this hospital exclusively and accounted for more than half of the admissions for sickle cell disease. CONCLUSIONS: A pain-control program modeled on regimens used to treat chronic cancer pain reduced hospital use by adult patients with sickle cell pain.