| HOW DO WE DEAL WITH CRISES? |
| Pain Management |
| Pain management techniques depend upon the level of pain experienced. Severe pain experienced from vaso-occlusive crises, or sickle cell crises requires drug therapy (i.e. narcotic analgesics) and psychological supportive care (Yale, Nagib, & Guthrie, 2000) that are available at hospitals of emergency room departments. However, Henderson (2000), reported that this type of pain management defers SCA patients' self-reliance. He concluded in response from a study conducted by Maxwell, Streetly, and Bevan (1999) that patients who manage their pain at home have a sense of responsibility, assertiveness, becomes an activist for self-education, and endures without hospital services. |
| Drug Therapy and Psychological Supportive Care |
| Hei and Lottenberg (2001) also criticized the treatment of painful crises. They suggested that insufficient and/or excessive treatment places the patient at greater risks of other complications. The authors agreed that "psychosocial support, identification and treatment of any precipitating factors, pain assessment, analgesia, and hydration" are the procedures for managing acute crises. |
| Behavioral Therapy |
| Past research (i.e. Thomas, Wilson-Barnett, and Goodhart, 1998; Porter et al., 2000) have suggested that behavioral therapy serves as an important factor in the management of physical and psychosocial pain. Rice (1985) identified behavioral analysis as an application that involves operant conditioning whereupon learned behavior is a result of consequences that follow the behavior. A reinforcer is the stimulus that followed the behavior and increased frequency of the response. In contrast, a punisher is defined as a stimulus that decreased the frequency of the response. The researcher further stated that: behavioral approaches to rehabilitation counseling involve assisting the disabled individual to acquire and maintain those functional behaviors that maximize his independence, and facilitates the individual's complete reintegration into his work, home, and social environment. |
| Cognitive Behavior Therapy |
| Thomas, Wilson-Barnett, and Goodhart (1998) conducted a pilot study in London that evaluated the implications of cognitive behavior therapy on pain management. The thirty jparticipants in their study were placed (10 each) into three groups: 1) cognitive behavioral therapy group, in which participants were encouraged to change their view about pain and self-perception from passive to active, 2) placebo group, in which subjects participated in patient-centered groups, and 3) the waiting list control group, in which patients received only medical treatment. These groups met 1 hour for 18 sessions. The results of their study suggested that " the opportunity to share feelings of distress, loneliness, and despair in a group with a qualified professional was both supportive and empowering". |
| Spirituality |
| Spirituality has also been a source of pain management for those dealing with physical and psychosocial issues. Trieschmann (2001) stated that "energy medicine," which is an association between spirituality and science, has improved the quality of life despite the fact of the disability or major illness itself. Nosek and Hughes (2001) concluded from their study that the participants demonstrated "an awareness of the limits of their control over their lives and surrender to the will of God to guide and protect them". |