Sickle cell disease: Gaining control over the pain

Multidisciplinary patient management offers additional treatment strategies such as social support, assistance with activities of daily living, and “day hospitals” for management of patients in a subacute setting. The day hospital model, which originated in 1989,¹¹ provides patients with access to a controlled environment where they can receive parenteral medication and hydration for the purpose of avoiding emergency care or inpatient hospitalization.

A 5-year-study of this model showed that patients were admitted to the hospital 5 times less often from the day hospital than from the emergency department. Also, the inpatient length of stay dropped by 1.5 days once the day hospital model was put into place.¹¹

Patients need help coping

The long-term effects of pain on physiology and psychology are well documented. Patients living with chronic pain may also have comorbidities such as anxiety, depression, and/or substance abuse. A tricyclic antidepressant or an SNRI may be worth considering for patients with sickle cell disease who are suffering from depression.

Many sickle cell patients feel isolated from others because of their constant pain and fear of the next sickle cell crisis.¹² A strong network of friends and family, empathetic health care providers, and a support network of other sickle cell patients who “truly understand” the pain of sickle cell disease can have a positive impact on the sickle cell patient. (For more on support groups, see the box below.) Shifting the focus away from inpatient hospitalization for pain management and onto outpatient maintenance and prevention of future crises will increase the overall quality of life of these patients.

Disclosure

The author reports that he serves on the speakers’ bureau of Aventine HealthSciences, a medical communications agency for pain and neuroscience.

References

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4. Centers for Disease Control and Prevention. Living Well With Sickle Cell Disease: Self-Care Toolkit. Available at: http://www.cdc.gov/ncbddd/sicklecell/documents/LivingWell-With-Sickle-Cell%20Disease_Self-Care Toolkit.pdf. Accessed June 30, 2012.
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