Treating sickle cell pain like cancer pain.

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.