Management

Recognized precipitating factors should be avoided, and the patient should be taught to seek out possible antecedent factors since avoiding these conditions may reduce the frequency of painful crises. The ability to cope with pain is influenced by many social and cultural factors, but reassurance and detailed explanation may do much to alleviate the sense of impending doom in the painful crisis.

Patients should be examined for infections and other precipitating factors which may need treatment. In addition to rest and reassurance, patients may be dehydrated and require fluids either by mouth or intravenously. Pain relief should be tailored to the patient's needs. Simple oral medications such as acetaminophen (paracetamol) are normally taken at home before attending but, if not, may contribute to pain relief. Stronger analgesics include codeine, pentazocine, pethidine, and morphine. These may be given by either intermittent parenteral routes or patient-controlled analgesia, which has the advantage of more sustained blood levels, better pain control at a lower overall consumption of drugs, and the psychological benefit of patient control. Analgesic requirements vary markedly between patients and in different cultures. In Jamaica, adequate pain relief may be achieved by modest levels of drugs, particularly in the context of other supportive measures.

The painful crisis is rarely a cause of admission to intensive care, although it may complicate an acute chest syndrome, pregnancy, and the postoperative period. It occasionally presents with features of disseminated intravascular coagulation.

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