Principles

• Treat underlying precipitating factors

• Avoid delays in analgesia administration

• Use pain scale to assess severity

• Choice of initial analgesic should be based on previous pain crisis pattern, history of response, current status, and other medical conditions

• Schedule pain medication; avoid as-needed dosing

• Provide rescue dose for breakthrough pain

• If adequate pain relief can be achieved with one or two doses of morphine, consider outpatient management with a weak opioid; otherwise hospitalization is needed for parenteral analgesics

• Frequently assess to evaluate pain severity and side effects; titrate dose as needed

• Treating adverse effects of opioids is part of pain management

• Consider nonpharmacologic intervention

• Transition to oral analgesics as the patient improves; choose an oral agent based on previous history, anticipated duration, and ability to swallow tablets; if sustained-release products are used, a fast-release product is also needed for breakthrough pain

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