Observations on the management of acute pain crisis in adult sickle cell disease in eastern Saudi Arabia

BACKGROUND: Sickle cell pain crisis continues to challenge patients and health professionals in places like Saudi Arabia, where the disease is common, and use of narcotic analgesics is strictly controlled. We sought to find the most effective and appropriate pain control regime for adult sickle cell pain crisis in Saudi Arabian patients. PATIENTS AND METHODS: Adult sickle cell disease patients in crisis, treated initially in the emergency room of a private health center, usually undergo further treatment with different pain control regimes in an observation ward. We compared the adequacy of pain conrol during the three recent years (2000–2002) with those of the preceding three (1995–1997). RESULTS: Treatment with regular opiates supplemented with oral analgesics during the second three-year period produced better results than “on demand” regimes. The former regimen enabled about 83% of patients from the second three-year period to be discharged home within two days compared with 71% during the first three-year period (P<0.05). A minority of patients needed more time for pain resolution. Patient response to oral analgesics was variable and females appeared to fare better than males. DISCUSSION: Greater empathy and individualized treatment are required for sickle cell pain crisis patients because of their variable clinical presentation, response to medications, and the regularity of pain in their lives. The observed gender differences in pain response require further study.