What is the best painkiller for sickle cell crisis?

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How can I care for my child?
Give pain medication (see home medication list for dosing).
Chronic Pain
Give constipation medication.
What else can I do for pain?
When should I call the clinic?

The health care team at Children's Minnesota believes that infants and children have a right to the best level of pain relief that can be safely provided. Therefore, we take a team approach to pain and anxiety management using drug and non-drug therapies. Our goal is to have staff and families work together to evaluate pain promptly and treat it effectively.

How can I care for my child?

Give extra fluids.

While the pain continues have your child drink about double the normal amount of water or any clear liquid. Examples are juice, ice chips, broth, soda, Jell-O®, Popsicles®.

The amount your child needs is based on weight. Check the chart for the amount to give during each 24 hours while in pain.

Weight in pounds (lb.)	Number of 8-ounce cups per day
10 lb.	2 cups
15 lb.	3 cups
20 lb.	4 cups
25 lb.	5 cups
30 lb.	5 to 6 cups
35 lb.	6 to 7 cups
40 lb.	7 cups
50 lb.	8 cups
60 lb.	9 cups
More than 60 lb.	10 or more cups

Give pain medication (see home medication list for dosing).

It is important to let your hematology provider know at a clinic visit that your child needs more opioids. Opioid medications cannot be called to a pharmacy.

Medication	Indication	Time
Ibuprofen (Motrin® or another brand)	Mild to moderate pain	Every 6 hours
Acetaminophen (Tylenol® or another brand)	Mild to moderate pain	Every 6 hours
Tramadol	Moderate or severe pain	Every 6 hours
Oxycodone	Moderate or severe pain	Every 6 hours

Alternate ibuprofen and acetaminophen so your child is receiving something every 3 hours. If having moderate pain, add tramadol or oxycodone every 6 hours in addition to tylenol and ibuprofen. Do not take both the tramadol and oxycodone, just take one of them. Continue this for 24-48 hours, then gradually give them less often, according to how your child feels. If child is sleeping, wake them to give pain medication to prevent uncontrolled escalation of pain.

Chronic Pain

Chronic pain is different than acute pain. If having chronic pain, make sure to take your daily chronic pain medications and perform your wellness activities. Contact your provider if needed for further instructions or advice.

Give constipation medication.

If your child is having hard stools, pain with bowel movements or a difficult time stooling, increase fluids and give constipation medications as prescribed (see home medication list, some common medications include miralax, colace and senna). Constipation is common with sickle cell disease and also common when taking opioids.

What else can I do for pain?

Give warm baths.
Use a warm moist towel or a heating pad. Make sure they are warm, not hot. Check the skin often to make sure it is not getting too warm.
Gentle massage of the area that hurts can be helpful.
Relaxation and distraction, such as quiet games, stories, music, or videos may help your child focus on other things.

When should I call the clinic?

Call for advice if:

vomiting, unable to keep medicines or fluids down
diarrhea
pain increases, or lasts longer than 72 hours
any concerns

Call to be seen right away if:

fever: temperature of 101.5º F (38.6º C) or higher
severe headache
dizziness
breathing problems
chest pain
severe stomach pain
swelling in abdomen (belly)
painful erection of the penis
any type of seizure
weakness
unable to move part of the body

If you cannot contact your provider, go to the emergency room.

Questions?

This information is for general use only. For specific medical advice or questions, consult your health care provider.

This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Minnesota Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

Medically Reviewed by Sabrina Felson, MD on August 21, 2022

Pain is a common problem for people with sickle cell disease. It happens when the sickle-shaped red blood cells that cause the condition get stuck in small blood vessels and block blood flow. That can cause a pain episode or crisis to start suddenly, usually in the lower back, arms, legs, chest, and belly. For others, health problems from sickle cell disease can cause pain that lasts longer and become chronic. Controlling pain associated with sickle cell can be difficult and could affect your mental health, causing stress and depression.

But no matter the type of sickle cell pain you have, there are many options that can help you find relief. Talk to your doctor about making a plan to manage your pain.

Most of the time, over-the-counter pain medicines like aspirin (Bayer, Bufferin), acetaminophen (Panadol, Tylenol), or ibuprofen (Advil, Motrin,Nuprin) can ease pain from an episode. (People under age 19 should not take aspirin, though.) There are some other things that may help, too:

Drink water or other fluids when your symptoms start. Staying hydrated can help you head off the worst of an attack.
Use a heating pad or take a warm bath.
Try a massage, acupuncture, or relaxation techniques.
Do something to take your mind off your pain. Watch TV, listen to music, or talk on the phone.

Most people can handle a pain crisis on their own at home. But if the pain doesn’t go away or is severe, you or your child may have to go to the hospital for more treatment. Your doctor may need to give you fluids through an IV, or they may prescribe more powerful painkillers.

Many doctors help people with sickle cell disease come up with a plan to manage pain episodes. It can guide you through specific steps to find pain relief on your own. It can also help other doctors, nurses, or paramedics know how to help you during an emergency. Ask your doctor to help you create one before an attack.

The drugs hydroxyurea (Droxia, Hydrea, Siklos) or voxelotor (Oxbryta), may keep pain episodes from happening as often for children and adults who take it every day. L-glutamine (Endari) may help you have shorter or fewer hospital visits for sickle cell pain. The most recent medication approved by the FDA is a monoclonal antibody called crizanlizumab-tmca (Adakveo). It is the first targeted therapy for SSD. It prevents red blood cell clumping thereby reducing vaso-occlusive crisis (VOC) which can cause pain as well as damage organs. Ask your doctor if either drug is right for you or your child.

The long-term effects of sickle cell disease can cause painful problems, especially for adults. For example, poor blood flow can damage bones and joints and cause chronic pain.

To help you with chronic pain, your doctor may prescribe painkillers to take every day. They may also recommend physical therapy or orthopedic devices to support your back or limbs. And in some cases, doctors may recommend surgery to correct a problem that’s hurting you, or temporarily numb a nerve to give you relief.

Living with sickle cell disease can be hard, especially for children. People who are in pain often may have problems with anxiety and depression. They may feel singled out or left out of things others enjoy because of their condition. These feelings can add to other problems the disease can cause.

If you feel stressed, sad, or overwhelmed, counseling or psychotherapy may be able to help. Talking about your problems with a mental health professional can help you find reliable, healthy ways to handle pain and other challenges of sickle cell disease.

Also, ask your doctor or nurse about support groups where you can connect with other people and families living with sickle cell disease. Together, you can share what life is like with the condition, and get advice on pain relief and other challenges.