{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:51:24Z","timestamp":1770817884623,"version":"3.50.1"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"23","license":[{"start":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T00:00:00Z","timestamp":1570838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>A novel strategy for management of acute pain associated with sickle cell disease (SCD), referred to as the oral tier approach, is described.<\/jats:p><\/jats:sec><jats:sec><jats:title>Summary<\/jats:title><jats:p>SCD is an inherited blood disorder characterized by episodic acute pain known as vaso-occlusive crisis (VOC), which is the most common reason for emergency department visits and hospital admissions in patients with SCD; these patients are often treated with parenteral opioids on admission and then transitioned to oral opioids prior to discharge. In this report, experience with use of the oral tier approach in 3 patients with SCD hospitalized for management of VOC is reported. As per usual practice, acute pain was initially managed with parenteral opioids via patient-controlled analgesia (PCA). Once pain control was established, an oral tier was added. The oral tier consisted of 3 orders. The first order was for an oral opioid, to be administered every 3 hours on a scheduled basis; however, the patient could refuse 1 or more of these scheduled doses. Two additional orders specified that the patients could receive additional oral opioids in incremental doses for moderate (grade 4\u20137) or severe (grade 8\u201310) pain if appropriate. To facilitate transition to an oral regimen with which the patients might be discharged, they were encouraged to use oral opioids in preference to parenteral opioids. Opioid usage and average daily pain scores for the 3 patients are reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Healthcare providers can use the oral tier approach to facilitate rapid inpatient conversion from i.v. PCA to oral opioids while providing adequate pain control in patients with SCD who develop VOC.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ajhp\/zxz228","type":"journal-article","created":{"date-parts":[[2019,10,12]],"date-time":"2019-10-12T03:58:47Z","timestamp":1570852727000},"page":"1965-1971","source":"Crossref","is-referenced-by-count":6,"title":["Inpatient pain management in sickle cell disease"],"prefix":"10.1093","volume":"76","author":[{"given":"Stefanie M","family":"Zassman","sequence":"first","affiliation":[{"name":"Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis J","family":"Zamora","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John D","family":"Roberts","sequence":"additional","affiliation":[{"name":"Yale Cancer Center, Yale University, New Haven, CT"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,10,12]]},"reference":[{"key":"2021060422073864000_CIT0001","author":"Centers for Disease Control and Prevention"},{"key":"2021060422073864000_CIT0002","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-1-4471-2473-3_1","volume-title":"Sickle cell disease in clinical practice","author":"Howard","year":"2015"},{"issue":"10","key":"2021060422073864000_CIT0003","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1001\/jama.2014.10517","article-title":"Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members","volume":"312","author":"Yawn","year":"2014","journal-title":"JAMA."},{"key":"2021060422073864000_CIT0004","volume-title":"The management of sickle cell disease","author":"National Heart, Lung, and Blood Institute"},{"issue":"24","key":"2021060422073864000_CIT0005","doi-asserted-by":"crossref","first-page":"3892","DOI":"10.1182\/blood-2013-05-498311","article-title":"Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies","volume":"122","author":"Manwani","year":"2013","journal-title":"Blood."},{"key":"2021060422073864000_CIT0006","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1111\/j.1749-6632.1989.tb24166.x","article-title":"Pain management in sickle cell disease","volume":"565","author":"Payne","year":"1989","journal-title":"Ann N Y Acad Sci."},{"issue":"3","key":"2021060422073864000_CIT0007","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.acpain.2004.08.002","article-title":"Persistent postoperative pain, health-related quality of life, and functioning 1 month after hospital discharge","volume":"6","author":"Strassels","year":"2004","journal-title":"Acute Pain."},{"issue":"5","key":"2021060422073864000_CIT0008","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/S0952-8180(02)00371-9","article-title":"Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs","volume":"14","author":"Coley","year":"2002","journal-title":"J Clin Anesth."},{"issue":"3","key":"2021060422073864000_CIT0009","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/S0304-3959(02)00458-X","article-title":"The impact of post-operative pain on outcomes following hip fracture","volume":"103","author":"Morrison","year":"2003","journal-title":"Pain."},{"key":"2021060422073864000_CIT0010","volume-title":"Morphine sulfate package insert","year":"1984"},{"key":"2021060422073864000_CIT0011","volume-title":"Dilaudid (hydromorphone) package insert","year":"1984"},{"issue":"4","key":"2021060422073864000_CIT0012","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1208\/s12248-008-9056-1","article-title":"Opioid tolerance development: a pharmacokinetic\/pharmacodynamic perspective","volume":"10","author":"Dumas","year":"2008","journal-title":"AAPS J."},{"issue":"4","key":"2021060422073864000_CIT0013","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1197\/aemj.10.4.390","article-title":"Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department","volume":"10","author":"Bijur","year":"2003","journal-title":"Acad Emerg Med."},{"issue":"2","key":"2021060422073864000_CIT0014","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jpain.2008.10.008","article-title":"Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain","volume":"10","author":"Chou","year":"2009","journal-title":"J Pain."},{"issue":"2","key":"2021060422073864000_CIT0015","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1016\/S0885-3924(01)00294-9","article-title":"Equianalgesic dose ratios for opioids. 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