Ballas S K
Cardeza Foundation for Hematologic Research, Jefferson Medical College, Philadelphia, PA 19107-5099, USA.
Curr Opin Hematol. 1997 Mar;4(2):104-11. doi: 10.1097/00062752-199704020-00005.
Sickle cell disease is characterized by recurrent episodes of acute pain. Some patients also suffer from chronic pain syndromes including avascular necrosis, leg ulcers, and intractable pain. Approaches to rational therapy of sickle pain include pharmacologic, nonpharmacologic, and preventive therapeutic interventions. Pharmacologic treatment of sickle pain entails the use of nonopioid analgesics, opioid analgesics, and adjuvants singly or in combination depending on the severity of pain. Meticulous evaluation and assessment of painful episodes should precede and accompany all approaches to management. The choice of the opioid analgesic, its route of administration, dose, and frequency of administration should be individualized on a case-by-case basis. Meperidine should be avoided whenever possible. Nonsteroidal anti-inflammatory drugs, meperidine, and morphine are contraindicated in the presence of renal failure. Administration of opioids on a fixed schedule or by patient-controlled analgesia is ideal for effective therapy. Nonpharmacologic approaches to manage sickle pain are underutilized and more studies are needed to determine their role in sickle pain. Preventive therapy of sickle pain is best achieved with hydroxyurea, which was found to decrease the frequency of crises significantly, decrease the incidence of acute chest syndrome, and decrease the need for blood transfusion.
镰状细胞病的特征是反复出现急性疼痛发作。一些患者还患有慢性疼痛综合征，包括缺血性坏死、腿部溃疡和顽固性疼痛。镰状细胞疼痛的合理治疗方法包括药物治疗、非药物治疗和预防性治疗干预措施。镰状细胞疼痛的药物治疗需要根据疼痛的严重程度单独或联合使用非阿片类镇痛药、阿片类镇痛药和辅助药物。在所有治疗方法之前和过程中，都应仔细评估和评估疼痛发作情况。阿片类镇痛药的选择、给药途径、剂量和给药频率应根据具体情况个体化。应尽可能避免使用哌替啶。在肾衰竭的情况下，非甾体抗炎药、哌替啶和吗啡是禁忌的。按固定时间表或通过患者自控镇痛给药阿片类药物是有效治疗的理想方式。镰状细胞疼痛的非药物治疗方法未得到充分利用，需要更多研究来确定它们在镰状细胞疼痛中的作用。镰状细胞疼痛的预防性治疗最好使用羟基脲，已发现其可显著降低危机发生频率、降低急性胸部综合征的发生率并减少输血需求。
