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Annals for Hospitalists Inpatient Notes - Clinical Pearls—Acute Pain Episodes in Sickle Cell Disease

A24-year-old woman with sickle cell anemia presents to the emergency department (ED) with severe (9 out of 10) pain in her lower back and legs. She has had moderate pain for 24 hours with poor sleep, reduced appetite, and good fluid intake. She took 600 mg of ibuprofen and 10 mg of oxycodone without improvement. She had no fever, shortness of breath, or cough. She takes oxycodone a few days per month and has 2 to 3 ED visits and 1 to 3 hospitalizations per year. She received 1 L of normal saline over 30 minutes, 30 mg of intravenous (IV) ketorolac, and 4 mg of IV morphine hourly for 3 doses, with a decrease in her pain score to 8 out of 10. She was subsequently hospitalized and prescribed patient-controlled analgesia (PCA) morphine and ketorolac.