Patient-Controlled Analgesia for Pain Crises

Sickle cell disease (SCD) can be very painful, especially during an acute pain crisis. This is also called a sickle cell or vaso-occlusive crisis. They can be sudden and may be triggered by different unknown risk factors.¹

These episodes of severe pain are the main reason people with SCD seek care in emergency rooms. However, many pain events may be managed at home. Patient-controlled analgesia may be an option for some people.¹

What is patient-controlled analgesia (PCA)?

Patient-controlled analgesia (PCA) is a kind of pain management system that lets you control when you get a dose of pain medicine. The pain medicine is typically an opioid, such as hydromorphone or morphine. You do not have to wait for a nurse or doctor, and you can get smaller amounts of medicine more often. This gives you more control of your pain relief.²

With PCA, you will have an intravenous (IV) line in a vein. A computerized pump attached to the IV allows you to release pain medicine when you press a button. Some pumps give a small, constant flow of medicine. Others give a set dose of pain medicine only when you push the button.^1,2

People can use a PCA at the hospital or at home. Adults and children over 7 years old can use PCA.^1,2

How do you safely use PCA?

A doctor needs to prescribe a PCA pump. They will decide on a starting dose of the medicine and how much you will get each time you press it. To keep you from an overdose, only a certain amount can be given over any given period of time. Your doctor and a nurse will make sure you know how to safely use it.²

Your vital signs and oxygen levels may be monitored while you use a PCA machine. To make sure you stay hydrated and keep your veins open, you may also get IV fluid in between doses of pain medicine.²

PCA is safe and effective. The main risks come from the opioid medicine. These risks include:²

• Allergic reaction
• Nausea or vomiting
• Low blood pressure
• Trouble breathing
• Sleepiness
• Constipation

Your doctor will watch you extra closely if you use PCA and:²

• Are older
• Have asthma or other lung problems
• Have obesity
• Have sleep apnea
• Need higher levels of pain medicine

When and why is PCA used for sickle cell disease?

A sickle cell crisis is an episode of severe pain caused by the blockage of small veins in the bone marrow. The blockage is caused by sickled cells. This then releases inflammatory chemicals, resulting in pain. Some people with SCD having a sickle cell crisis can manage it with non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibruprofen at home. However, some may need to seek pain relief at the hospital.³

To treat sickle cell crisis at the hospital, pain treatment typically involves morphine given through an IV. Studies have shown that when people with SCD are given PCA for a sickle cell crisis, they use much less morphine than if they had a continuous infusion. They also had improved quality of life.³

What are the pros and cons of PCA?

When compared to other forms of pain management in hospitals, there are some pros and cons of PCA. For one, it may work better for some people than others. Other pros include:^3-5

• The ability to control the amount and timing of pain medicine
• Overall lower morphine consumption compared to an infusion
• Potential shorter length of stay in the hospital
• Increased mobility
• Reduced anxiety and depression because you control the pain medicine
• Reduced sleepiness because of less morphine
• Overall reduction of pain because you can treat the pain immediately instead of waiting

Cons of PCA may include:⁶

• You may not know when you are getting the medicine as you press the button, which can lead to anxiety about pain when you have pressed the PCA button too much and are unable to get any more medicine for a period of time
• Difficulties using the machine, leading to anxiety

If you think PCA might be helpful for you, talk with your doctor about whether it is right for you. If you do get a PCA device, ask your doctor or nurse any questions you may have. Knowing how to use it and being comfortable with can help make it easier to use and better control your pain.