Nonpharmacologic treatment of pain from sickle-cell disease

Several of my patients with sickle-cell disease experience chronic pain. This pain is currently managed using a combination of nonsteroidal anti-inflammatory drugs and opioids when appropriate. Are there any nonpharmacologic treatment measures that have been effective in managing pain associated with sickle-cell disease (e.g., acupuncture, massage, transcutaneous electrical nerve stimulation, etc.)?—ANGELA LAMBING, MSN, NP-C, Detroit

The American Pain Society released a comprehensive pain management guideline for chronic sickle cell pain in 1999. The guideline emphasizes individualization of therapy coupled with the use of nonpharmacologic and pharmacologic approaches. Heat or ice packs, relaxation, distraction, music, massage, vibration, prayer, therapeutic exercises, menthol cream rub, self-hypnosis, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS), and biofeedback have all been used with anecdotal success. There are no controlled clinical trials on the efficacy of any of these modalities in the management of sickle cell pain. Cognitive therapies can also be used to enhance coping strategies and reduce negative thoughts. The integration of these modalities as well as basic wellness habits of hydration, nutrition, and sleep into treatment should be culturally sensitive and tailored to the patient's individual needs. For more information, see Hematology Am Soc Hematol Educ Program. 2007:97-105.—Sherril Sego, FNP-C, DNP (138-5)

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