Sickle cell disease: managing acute painful episodes in hospital

Ongoing pain relief and monitoring

Healthcare professionals should check how well your pain relief is working. This should be done every 30 minutes until you are comfortable, and then at least every 4 hours after that. They should ask you how well the last painkiller you had worked and whether you feel you need more pain relief. They should also use a pain scoring tool that is suitable for you.

If you are still in severe pain despite having had a first dose of a strong opioid, you should be offered a second dose. If you had a weak opioid for moderate pain at first but your pain has got worse, you should now be offered a strong opioid.

If you need repeated doses of a strong opioid within a 2-hour period, you may be able to use a device that allows you to control the amount of medication you have yourself. This is called patient-controlled analgesia, or PCA for short.

You should be offered medication to help with the side effects of opioids, such as regular laxatives to avoid constipation, and anti-sickness and anti-itch drugs if you need them. If you are taking a strong opioid, you should be monitored regularly for possible side effects. You should have an assessment (for example, to see how alert you are) every hour for the first 6 hours, and then at least every 4 hours after that.

Healthcare professionals should encourage you to use your own ways of coping with the pain if these help you. Examples include techniques to help you relax, such as massage or reflexology.

If the usual treatments for an acute painful sickle cell episode don't seem to be working, you should be reassessed to see if something else might be causing your symptoms.

As your pain improves, your healthcare team should gradually reduce the amount of pain relief you have, after discussing this with you.