Document Type

Article

Publication Date

1-1-2011

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Hemoglobin

Volume 35, Issue 5-6, October 2011, Pages 520-529.

The published version is available at DOI: 10.3109/03630269.2011.610478. Copyright © Informa

Abstract

Acute pain is the hallmark of sickle cell disease and is the most common cause of hospital admissions. Tissue damage due to vaso-occlusion releases numerous inflammatory mediators that initiate the transmission of painful stimuli that culminate in the perception of pain. The acute sickle cell painful crisis evolves along four phases. Each phase is coupled with changes in certain markers of the disease. Hospital readmission occurs within 1 week in about 16% of discharged patients and within 1 month in about 50% of discharged patients. Failure to treat acute pain aggressively may lead to chronic pain syndrome which, in turn, initiates neuropathic pain. Management of sickle pain is primarily pharmacological in nature and opioids are the analgesics used most often. Adverse effects of opioids include histaminergic, excitatory, dopaminergic and proserotonergic effects. Cellular and molecular mechanisms of opioids explain individual differences among patients and justify the use of individualized treatment plans.

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