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 or 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. Conclusion: A pain-control program modeled on regimens used to treat chronic cancer pain reduced hospital use by adult patients with sickle cell pain.