Synopsis
Treat acute sickle pain promptly and respectfully, identify alternative or complicated causes, titrate multimodal analgesia, and reassess function, toxicity and discharge safety.
- A vaso-occlusive episode is acute pain from microvascular obstruction and inflammation, usually in bone or marrow but potentially involving any organ.
- Pain is whatever the patient says it is; previous opioid exposure and individual care plans should inform rather than discredit the assessment.
- Use the person's analgesia plan when available, assess pain, observations and recent medicines, and deliver initial analgesia within 30 minutes of arrival.
Key red flags
New cough, chest pain, falling saturation, tachypnoea or fever during treatment raises acute chest syndrome and needs immediate reassessment.
Investigation priorities
Identify physiological compromise and establish an analgesia baseline.
Management branches
A person with sickle-cell disease presents with an acute painful episode.
- Record pain, respiratory and cardiovascular observations, compare with the individual care plan and screen for chest, neurological, septic, abdominal and priapism red flags.
- Give initial analgesia within 30 minutes: a strong opioid by an appropriate route for severe pain, with paracetamol and an NSAID when not contraindicated.
Key medicines
Morphine sulfateFor severe pain use the individual plan or local acute-sickle protocol for rapid intravenous or subcutaneous titration, then consider patient-controlled analgesia with opioid-tolerance adjustment.
ParacetamolGive 1 g orally or intravenously up to four times daily in most adults, reducing the maximum for low body weight, liver disease, malnutrition or chronic alcohol risk.