Frequently asked questions by hospitalists managing pain in adults with sickle cell disease
Division of General Internal Medicine, Adult Sickle Cell Program, Department of Internal Medicine, Virginia Commonwealth University, 1200 E. Broad St., Box 980306, Richmond, VA 23298‐0306
Pain is the predominant medical presentation to hospitalists for patients with sickle cell disease (SCD). Dramatic treatment gains of SCD in childhood have resulted in more adults now requiring hospitalization than children. This has created new challenges to improve the quality of hospital care for SCD. The evidence base for pain management in SCD is lacking. We therefore offer some evidence and our informed opinion to answer frequently asked questions (FAQs) about pain management by hospitalists caring for adults with SCD. The most common questions center around defining a crisis; selecting and managing opioids; distinguishing between opioid tolerance, physical dependence, and addiction or misuse; determining appropriateness of discharge; and avoiding lengthy or recurrent hospitalizations. Journal of Hospital Medicine 2011. © 2011 Society of Hospital Medicine.