Patients with sickle cell disease (SCD) who received an individualized pain treatment protocol during vaso-occlusive episodes had a more rapid reduction in pain than those who received weight-based dosing, according to a study published in the European Journal of Haematology.
During vaso-occlusive episodes, patients with SCD often require opioids for pain management. Both the National Heart, Lung, and Blood Institute (NHLBI) and the American Society of Hematology (ASH) recommend the initiation of pain treatment within 60 minutes of presentation.
Although there is evidence that a personalized approach to pain management achieves better outcomes in patients with SCD experiencing vaso-occlusive episodes, emergency departments remain under pressure to provide rapid relief as soon as possible, which is seen to be more achievable under weight-based dosing.
The authors of this study sought to compare the 2 approaches to determine which one best achieves timely pain relief, as reported by patients. Patients with SCD (n=49) were recruited and randomized to receive either a patient-specific or standard weight-based pain treatment protocol. Both of these protocols were based on NHLBI recommendations for the management of vaso-occlusive episodes in SCD.
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Pain was measured using the visual analog scale, and it was assessed every 30 minutes over a 6-hour period (360 minutes) or until a medical decision to admit or discharge the patient was made.
The researchers analyzed 122 emergency department visits due to patients having multiple vaso-occlusive episodes during the 13-month study period. They reported that a 30% reduction in pain during the initial 6 hours occurred in 70.5% of emergency visits in patients who received individualized pain management protocols; in contrast, only 62.3% of patients who received standard weight-based protocols reported the same outcome.
“The difference for patients is clear; pain relief is achieved sooner when using an individualized protocol,” the authors of the study concluded.
Tanabe P, Bosworth HB, Crawford RD, et al. Time to pain relief: a randomized controlled trial in the emergency department during vaso-occlusive episodes in sickle cell disease. Eur J Haematol. Published online January 5, 2023. doi:10.1111/ejh.13924