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This article has been peer reviewed. It is the authors' final version prior to publication in Journal of Pain and Symptom Management Volume 40, Issue 6, December 2010, Pages 870-882. The published version is available at DOI: 10.1016/j.jpainsymman.2010.03.020. Copyright © Elsevier Inc.


Recurrent acute sickle cell painful crises are the hallmark of sickle cell anemia. These events may be mild, moderate or severe in nature and often require treatment at home, in acute care facilities as outpatients, and in the hospital with oral and/or parenteral opioids. The type, dose, route & frequency of administration of opioids, as well as the length of hospital stay (LOS), are not well known for adults with sickle cell anemia (SS). We analyzed these aspects in the 299 patients enrolled in the Multicenter Study of Hydroxyurea (MSH) in SS. For these patients there were 16818 home diaries, 2249 acute care contacts, and 2209 hospitalizations. At home analgesics were used on 40% of diary days and 80% of 2-week follow up periods, with oxycodone and codeine the most frequently used. Responders to hydroxyurea (HU) used analgesics on fewer days. During hospitalization 96% were treated with parenteral opioids, with meperidine the most frequently used; oxycodone was the most commonly used oral medication. The average LOS for responders to HU was about two days less than for other groups and their cumulative time hospitalized during the trial was significantly less than for nonresponders or placebo groups (p<0.022). They also had the lowest doses of parenteral opioids during acute care crises (p=.015).