● Guideline 8 : Given the lack of evidence and the potential legal and political obstacles we cannot recommend the use of cannabinoids in the treatment of acute burn pain (Level D). ● Guideline 9 : Regional anesthesia for burn pain management has the potential to provide improved pain relief, patient satisfaction, and opioid use reduction without serious risks or complications. Given the limited amount of good- quality evidence, we cannot at this time make specific recommendations about either the timing or dosing of regional anesthesia techniques or the potential long-term benefits of early regional anesthesia use in this population (Level C). Non-drug treatment ● Guideline 1 : We recommend that every patient be offered a nonpharmacological pain control technique, at least as an adjunctive measure to their pain control regimen. When the expertise and/or equipment is available, cognitive-behavioral therapy, hypnosis, and virtual reality have the strongest evidence (Level A). 3. For adults and children presenting with acute pain related to SCD who are hospitalized, the ASH guideline panel suggests a subanesthetic (analgesic) ketamine infusion as adjunctive treatment of pain that is refractory or not effectively treated with opioids alone (conditional recommendation based on very low certainty in the evidence about effects). 4. For adults and children presenting with acute pain related to SCD, the ASH guideline panel suggests regional anesthesia treatment approaches for localized pain that is refractory or not effectively treated with opioids alone (conditional recommendation based on very low certainty in the evidence about effects). Nonpharmacological therapies for acute SCD pain Care Question : Should nonpharmacological therapies in addition to pharmacological therapies be used for the treatment of acute pain in children and adults with SCD? 1. For adults and children who seek treatment for acute pain, the ASH guideline panel suggests massage, yoga, transcutaneous electrical nerve stimulation (TENS), virtual reality (VR), and guided audiovisual (AV) relaxation in addition to standard pharmacological management (conditional recommendation based on very low certainty in the evidence about effects). Nonpharmacological therapies for chronic SCD pain Care Question : Should nonpharmacological therapies be used in addition to pharmacological therapy for the treatment of chronic pain in children and adults with SCD? 1. For adults and children with SCD who have chronic pain related to SCD, the ASH guideline panel suggests cognitive and behavioral pain management strategies in the context of a comprehensive disease and pain management plan (conditional recommendation based on very low certainty in the evidence about effects). Pain management in SCD-Specific hospital-based acute care setting Care Question: Should a hospital-based entity such as a day hospital or observation unit compared with regular ED care be used for children and adults with SCD who seek treatment for acute pain? 1. For adults and children who develop acute pain episodes requiring hospital care, the ASH guideline panel suggests using SCD-specific hospital-based acute care facilities (i.e., day hospitals and infusion centers, all with appropriate expertise to evaluate, diagnose, and treat pain and other SCD complications) over typical ED-based care (conditional recommendation based on low certainty in the evidence about effects).
patients should be aware of potential adverse effects, which may become more profound with dose escalation (Level C). ● Guideline 4 : Ketamine should be considered for procedural sedation, utilizing appropriate training and monitoring for the physician and nursing staff who are administering it (Level B). ● Guideline 5 : Low-dose ketamine should be considered as an adjunct to opioid therapy in patients who could benefit from reduced opioid consumption, particularly in the postoperative period (Level D). ● Guideline 6 : Dexmedetomidine and clonidine are recommended as pain management adjuncts, particularly in patients showing signs of withdrawal or prominent anxiety symptoms, and dexmedetomidine as a first-line sedative in the intubated burn patient (Level D). ● Guideline 7 : The use of IV lidocaine for burn pain management cannot be recommended at this time as a first-line agent, but it is a reasonable second- or third-line adjuvant agent (Level D). for children and adults with SCD. The recommendations of this guideline are based on updated and original systematic reviews of evidence conducted under the direction of the Mayo Evidence-Based Practice Research Program. The recommendations in this guideline are consistent with the theme of this course. Standardized protocol for acute scd pain in acute care setting Care Question : In children and adults who seek treatment of acute pain, should a standardized protocol be used that includes (1) reduced time to first dose (<1 hour from arrival) in addition to more frequent reassessment and dosing of pain medication (<30 minutes) and (2) tailored dosing (versus weight-based dosing)? 1. For adults and children with SCD presenting to an acute care setting with acute pain related to SCD for whom opioid therapy is indicated, the ASH guideline panel suggests tailored opioid dosing based on consideration of baseline opioid therapy and prior effective therapy ( for adults : conditional recommendation based on moderate certainty in the evidence about effects; for children : conditional recommendation based on low certainty in the evidence about effects). 2. For adults and children with SCD presenting to an acute care setting with acute pain related to SCD, the ASH guideline panel recommends rapid (within 1 hour of emergency department [ED] arrival) assessment and administration of analgesia with frequent reassessments (every 30-60 minutes) to optimize pain control (strong recommendation based on low certainty in the evidence about effects). Nonopioid pharmacological therapies for acute SCD pain Care Question : Should nonopioid pharmacological therapies either in addition to or instead of opioids or other usual care interventions be used for the treatment of acute pain in children and adults with SCD? 1. For adults and children with acute pain related to SCD, the ASH guideline panel suggests a short course (5 to 7 days) of nonsteroidal anti-inflammatory drugs (NSAIDs) in addition to opioids for acute pain management (conditional recommendation based on very low certainty in the evidence about effects). 2. For adults and children presenting for acute pain related to SCD, the ASH guideline panel suggests against corticosteroids for acute pain management (conditional recommendation based on low certainty in the evidence about effects).
American Society of Hematology Guideline for Pain in Sickle Cell Disease (SCD) Designed by the American Society of Hematology, this evidence- based guideline is intended to support patients, clinicians, and other healthcare professionals in pain management decisions
Book Code: PYFL4024
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