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| Non-Pharmacologic Interventions | |||||||||||||||||||||||
| Prevention and Specific Therapy | |||||||||||||||||||||||
| Nonpharmacologic approaches to therapy are important in managing all types of pain in sickle cell patients, but may provide the greatest benefit in management of frequent acute pain and chronic pain states. It is important to realize that behavioral modification in the health care provider that increases perception of the patient's pain and improves response to pain will also result in better control of the patient's discomfort. Behavioral modification is often of paramount importance in managing sickle pain. Identifying and modifying social, occupational, and behavioral precipitants of pain can dramatically reduce the frequency of acute pain episodes and reduce the intensity of chronic pain. Young adults may develop a pattern of increasing frequency of acute pain episodes related to the physical and psychologic demands of obtaining social and economic independence. Behavioral contracting has been shown to improve pain behavior in adoslescent patients with sickle cell disease. Physical and occupational therapy may dramatically reduce pain, improve functioning, and prevent progression of complications that cause chronic pain in sickle cell disease. Peer support and group discussions are important in educating the patient about approaches that will directly minimize pain and maximize the therapeutic benefit of medications. Localized pain in selected patients may respond to transcutaneous electric nerve stimulation (TENS), local mechanical stimulation, acupuncture, or nerve blocks. Cognitive and behavioral techniques like biofeedback, hypnosis and self-hypnosis, relaxation techniques, diversion, and motivational therapy all should be considered in management. Physiotherapy using heat, hydrotherapy, massage, and exercise may reduce pain and improve function. | |||||||||||||||||||||||
| Females with frequent pain episodes associated with menstrual periods may benefit from administration of progesterone-based birth control pills or depoprovera preparations. Therapy directed at healing leg ulcers are critical to reducing associated pain. Topical therapy with occlusive dressings may directly improve pain. Avascular necrosis of the hips and shoulders may benefit from orthopedic intervention if the pain is disabling. Core decompression of the hip is being explored as early palliative therapy for pain and to prevent the rate of progression. | |||||||||||||||||||||||
| Future Directions | |||||||||||||||||||||||
| There have been great advances in the treatment of sickle cell disease reducing morbidity and improving survival. Management of pain continues to be the major unmet challenge that requires further research by individuals who are knowledgeable about pain and sickle cell disease. Education about mechanisms of pain and pain control in sickle cell disease needs to be improved for all health care providers. Attitudes and behavior of health care providers needs to be improved to achieve more effective treatment of pain and to reduce suffering in sickle patients. Newborn screening and adolescent transition programs provide opportunities for preventing of maladaptive pain behavior in the future. | |||||||||||||||||||||||
| CONTINUE | |||||||||||||||||||||||
| Non-pharmacologic pain management strategies | |||||||||||||||||||||||
| Physical and Occupational Interventions | |||||||||||||||||||||||
| * heat and cold * physical therapy * transcutaneous nerve stimulation (tens) * acupuncture and acupressure * vocational rehabilitation |
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| Self-regulatory Techniques | |||||||||||||||||||||||
| * progressive relaxation * meditative breathing * guided imagery * hypnosis * biofeedback |
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| Psychological Interventions | |||||||||||||||||||||||
| * individual and family therapy * support groups * behavioral contracting & contingency management * coping skills training |
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