Sickle Cell Crisis and Pain Management: Pathophysiology

[Soliloquy, MSN, APRN, NP]

I understand that pain is the 6th vital sign. but what is the pathophysiological reason that we manage pain in sickle cell crisis? My thinking was that pain is a sign that the RBCs are beginning to occlude the vessels BUT, that's why you give patients aspirin and other blood thinners, not to manage their pain, although it can. My other thinking was that pain was often the pain reason patients return to the hospital and it affects overall quality of life.

Why else is pain management important in sickle cell crisis?

[LCinTraining]

We just learned that pain was considered a safety issue. I haven't quite figured out why in my head, but I know that safety is a priorty with nursing diagnoses. So pain must be managed. We also learned that this pain can last a while. Long term (lasting days on end) intense pain is enough to drive anyone crazy.

[Jazziepants]

I know that besides the fact they occlude, they are also sharp d/t their malformation and scrape again the vessel walls as they pass which is very painful.

[classicdame, MSN, EdD]

the major risk with sickle cell is chest syndrome and can be fatal. Pain is a symptom of "something wrong" so the lab values and maybe a chest x-ray would be needed to determine if this patient is having symptoms of chest sydrome. Occlusions also cause stoke and emboli.

[Soliloquy, MSN, APRN, NP]

Thanks everyone.

classicdame, that makes sense. So pain in and of itself isn't the pain problem (didn't think so) though it should be treated, but it is something one needs to look into further.

Okie dokie! Next time I'm in the hospital, I'll be sure to play extra nosey. I need to keep on practicing. lol

[Esme12, ASN, BSN, RN]

Agreed.......the signal of pain is that there is a crisis in the body. a signal that something is amiss. Pain and Sickle cell crisis

http://www.emedicinehealth.com/sickle_cell_crisis/article_em.htm

[ckh23, BSN, RN]

Another reason is because of what pain does to the body. Increases in HR and BP, that can be seen in patients with pain, can make the crisis even worse. When your BP is going up, your vessels are constricting and making the occlusion worse and risking more occlusions elsewhere in the body.

[nurseprnRN, BSN, RN]

The pain of sickle cell crisis is largely related to the occlusion of the capillaries by those sickled cells. What happens if you decrease blood flow to a tissue? Think it hurts? Why? What would you do for that? Why is the aspirin given (hint, it won't begin to touch real sickle cell crisis pain and that's not why it's given) ?