Time to pain relief: A randomized controlled trial in the emergency department during vaso-occlusive episodes in sickle cell disease.

Tanabe P, Bosworth HB, Crawford RD, Glassberg J, Miller CN, Paice JA, Silva S. Time to pain relief: A randomized controlled trial in the emergency department during vaso-occlusive episodes in sickle cell disease. European journal of haematology. 2023 May 1; 110(5):518-526.

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Abstract:

OBJECTIVE: Compare time to pain relief (minimum of a 13 mm and 30% reduction) during an Emergency Department (ED) visit among patients with sickle cell disease (SCD) experiencing severe pain associated with a vaso-occlusive episode who were randomized to receive either an individualized or weight-based pain protocol. METHODS: A randomized controlled trial in two EDs. Adults with sickle cell disease. Research staff recorded pain scores every 30 min during an ED visit (up to 6 h in the ED) using a 0-100 mm visual analogue scale. Analysis included 122 visits, representing 49 patients (individualized: 61 visits, 25 patients; standard: 61 visits, 24 patients). RESULTS: Pain reduction across 6-h was greater for the individualized compared to the standard protocol (protocol-by-time: p  =  .02; 6-h adjusted pain score comparison: Individualized: M  =  29.2, SD  =  38.8, standard: M  =  45.3, SD  =  35.6; p  =  .03, Cohen d  =  0.43). Hazards models indicated a greater probability of 13 mm (HR  =  1.54, 95% CI  =  1.05, 2.27, p  =  .03) and 30% (HR  =  1.71, 95% CI  =  1.11, 2.63, p  =  .01) reduction in the individualized relative to the standard protocol. CONCLUSIONS: Patients who received treatment with an individualized protocol experienced a more rapid reduction in pain, including a 13 mm and 30% reduction in pain scores when compared to those that received weight-based dosing.