Vaso-occlusive crisis- Pain

The most common complication in SCD is a vaso-occlusive crisis (VOC). These episodes usually present with sudden onset of severe pain, often localized to the extremities, chest, or back, but with few objective findings. Nearly all persons with SCD will have a VOC during their lifetime sometimes as early as six months of age, when it presents as dactylitis. Recurrences have variable presentations and frequency. VOC is a clinical diagnosis with no objective diagnostic tests. Other potential causes for the acute pain should be excluded while providing required analgesia. Primary management of VOC includes rapid triage, assessment, and administration of appropriate analgesics. Pain management should be based on patient-reported pain severity. For mild or moderate pain, treatment may begin with nonsteroidal anti-inflammatory drugs, if they are not contraindicated. For more severe pain, opioids are the first-line therapy; they should be provided immediately and therapy should be guided by the patient's history of previous successful regimens. Meperidine (Demerol) should not be used unless it is the only effective alternative available. Hydration and other nonpharmacologic therapies (e.g. maintaining body temperature) may also be useful.

From : Management of Sickle Cell Disease: Recommendations from the 2014 Expert Panel Report