Udezue Emmanuel, Girshab Abdel Moneim
Saudi Aramco Medical Services Organization, Mubarraz, Saudi Arabia.
Ann Saudi Med. 2005 Mar-Apr;25(2):115-9. doi: 10.5144/0256-4947.2005.115.
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.
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).
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.
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.
在沙特阿拉伯等疾病常见且严格控制麻醉性镇痛药使用的地方，镰状细胞疼痛危象持续困扰着患者和医护人员。我们试图为沙特阿拉伯成年镰状细胞疼痛危象患者找到最有效且合适的疼痛控制方案。
处于疼痛危象的成年镰状细胞病患者最初在一家私立健康中心的急诊室接受治疗，之后通常会在观察病房接受不同疼痛控制方案的进一步治疗。我们比较了最近三年（2000 - 2002年）与前三年（1995 - 1997年）疼痛控制的充分程度。
在第二个三年期间，采用常规阿片类药物辅以口服镇痛药的治疗方案比“按需给药”方案产生了更好的效果。与第一个三年期间71%的患者相比，第二个三年期间约83%的患者能够在两天内出院回家（P<0.05）。少数患者需要更多时间来缓解疼痛。患者对口服镇痛药的反应各不相同，女性患者的情况似乎比男性更好。
由于镰状细胞疼痛危象患者临床表现各异、对药物反应不同且疼痛具有规律性，因此需要给予他们更多的同理心和个体化治疗。观察到的疼痛反应中的性别差异需要进一步研究。
