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Article Excerpt
Sickle cell disease (SCD) is a genetic disorder characterized by a partial or complete replacement of normal hemoglobin (HgbA) with abnormal hemoglobin S (HgbS). The most challenging aspect of the disease is the recurrent vaso-occlusive episode (VOE) as a result of sickled-shaped red blood cells. The purpose of this study was to examine the pain experience and the effectiveness of analgesics for hospitalized adults with SCD.
Acute painful VOE is the most common manifestation of SCD (Yaster, Kost-Byerly, & Maxwell, 2000), and is the most common cause of hospitalization for adults with SCD (Ballas & Lusardi, 2005; Yale, Nagib, & Guthrie, 2000; Yaster et al., 2000). These painful episodes are caused by stasis of sickle-shaped erythrocytes; the cells occlude the microcirculation, causing ischemia and infarction. The pain commonly occurs in the bone and generally involves the lower back, chest, femoral shaft, hip joints, ribs, knees, abdomen, and head. Moreover, these painful episodes are recurrent, unpredictable, intense, and relentless, generally lasting 3-14 days (Yaster et al., 2000).
The severity of SCD is variable among patients. Fortunately, the majority of patients with SCD experience few or no acute painful episodes in their lifetimes. Many patients experience mild vaso-occlusive painful episodes that last for short periods of time and can be managed at home (Yaster et al., 2000). Only a small percentage of patients with SCD experience frequent, severe, and prolonged episodes requiring hospitalization (Beyer, Platt, Kinney, & Treadwell, 1999; Castro, Hoque, & Brown, 2003; Houston-Yu, Rana, Beyer, & Castro, 2003; Steinberg, 1999). However, this 5% of patients with SCD accounts for more than 30% of hospital admissions for SCD in a given year (Yaster et al., 2000). The purpose of this study was to examine pain experience and evaluate pain management in adult patients with SCD who were hospitalized for acute painful episodes. In addition, pain intensity ratings and analgesic use between episodes that were short (less than 1 week) and prolonged (greater than 1 week) were compared.
Review of the Literature
A nursing and health sciences database was used to conduct an extensive review of the literature. The literature revealed a variety of reasons why inadequate pain management continues to exist for adults admitted for VOE. For instance, the literature focuses primarily on factors that affect the management of pain, including pharmacologic regimens, methods of analgesic administration, and non-pharmacologic, strategies, as well as perceptions of health care practitioners regarding sickle cell pain (Shapiro, Benjamin, Payne, & Heidrich, 1997; Steinberg, 1999; Yale et al., 2000). A growing number of studies are examining the pain experience in children and adolescents (Franck, Treadwell, Jacob, & Vichinsky, 2002; Jacob et al., 2003a, 2003b; Jacob & Mueller, 2007). However, little attention has been paid to the pain experience of adults with SCD.
In an important recent study, Ballas and Lusardi (2005) evaluated the pattern of hospital admissions of patients with SCD, the causes for frequent hospital readmissions, and the significance of the patients' prognosis. Researchers specifically examined the frequency, etiology, and prognostic significance of readmission within 1 week and 1 month after initial discharge. They found 50% of patients admitted for acute painful episodes were readmitted within 1 month after discharge, and approximately 16% were readmitted within 1 week after discharge. The researchers defined severe pain as a pain intensity greater than 6 on a 0-10 numerical rating scale. For 50% of the patients discharged to home, mean pain intensity score greater than 7 suggested premature discharge. In addition, significant correlations existed between the pain scores on admission and discharge (p<0.001), and a significant correlation existed between the pain score on admission and the hospital length of stay (p=0.006). Patients who had high pain scores on admission were more likely to...
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