PAIN DUE TO SICKLE-CELL CRISES IN PEDIATRIC-PATIENTS - SEMIOLOGY, EVALUATION, AND MANAGEMENT - ROLE OF MAJOR ANALGESICS

Pain is a prominent manifestation of sickle cell anemia, Vasoocclusive crises are a significant problem in approximately one of every three patients and remain difficult to predict despite the identification of a number of precipitating factors, The pain is of variable severity and produces a range of clinical manifestations in children (crying, agitation, postures aimed at relieving pain, psychomotor listlessness), Evaluation rests on patient diary data and on tools such as visual analog scales acid the DGER scale, Analgesic therapy should be given according to the stepped care approach recommended by the WHO, Peripheral analgesics, nonsteroidal antiinflammatory agents and mild narcotics (codeine, dextropropoxyphene) are adequate for moderately severe crises, Data from a review of the literature suggest that morphine is often indicated in severe crises, in combination with conventional measures (hospitalisation, hydration, blood transfusion of needed). Administration can be via a preset patient-controlled pump, Improved pain control is conducive to increased trust of patients in health care providers. Published studies suggest that the risk of narcotic-induced complications (respiratory depression, addiction) is very low.