{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T16:10:50Z","timestamp":1776615050588,"version":"3.51.2"},"reference-count":37,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T00:00:00Z","timestamp":1432598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pain Practice"],"published-print":{"date-parts":[[2016,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Sickle cell disease (<jats:styled-content style=\"fixed-case\">SCD<\/jats:styled-content>) is a worldwide distributed hereditary red cell disorder. The principal clinical manifestations of<jats:styled-content style=\"fixed-case\">SCD<\/jats:styled-content>are the chronic hemolytic anemia and the acute vaso\u2010occlusive crisis (<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s), which are mainly characterized by ischemic\/reperfusion tissue injury. Pain is the main symptom of<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s, and its management is still a challenge for hematologists, requiring a multidisciplinary approach.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We carried out a crossover study on adult<jats:styled-content style=\"fixed-case\">SCD<\/jats:styled-content>patients, who received two different types of multimodal analgesia during two separate severe<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s with time interval between<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s of at least 6\u00a0months. The first<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>episode was treated with ketorolac (0.86\u00a0mg\/kg\/day) and tramadol (7.2\u00a0mg\/kg\/day) (<jats:styled-content style=\"fixed-case\">TK<\/jats:styled-content>treatment). In the second<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>episode, fentanyl buccal tablet (<jats:styled-content style=\"fixed-case\">FBT<\/jats:styled-content>; 100\u00a0\u03bcg) was introduced in a single dose after three hours from the beginning of<jats:styled-content style=\"fixed-case\">TK<\/jats:styled-content>analgesia (<jats:styled-content style=\"fixed-case\">TKF<\/jats:styled-content>treatment). We focused on the first 24\u00a0hours of acute pain management. The primary efficacy measure was the time\u2010weighted\u2010sum of pain intensity differences (<jats:styled-content style=\"fixed-case\">SPID<\/jats:styled-content>24). The secondary efficacy measures included the pain intensity difference (<jats:styled-content style=\"fixed-case\">PID<\/jats:styled-content>), the total pain relief (<jats:styled-content style=\"fixed-case\">TOTPAR<\/jats:styled-content>), and the time\u2010wighted sum of anxiety (<jats:styled-content style=\"fixed-case\">SAID<\/jats:styled-content>24).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">SPID<\/jats:styled-content>24 was significantly higher in<jats:styled-content style=\"fixed-case\">TKF<\/jats:styled-content>than in<jats:styled-content style=\"fixed-case\">TK<\/jats:styled-content>treatment. All the secondary measures were significantly ameliorated in<jats:styled-content style=\"fixed-case\">TKF<\/jats:styled-content>compared to<jats:styled-content style=\"fixed-case\">TK<\/jats:styled-content>treatment, without major opioid side effects. Patients satisfaction was higher with<jats:styled-content style=\"fixed-case\">TKF<\/jats:styled-content>treatment than with<jats:styled-content style=\"fixed-case\">TK<\/jats:styled-content>one.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We propose that<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s might require breakthrough pain drug strategy as vaso\u2010occlusive phenomena and enhanced vasoconstriction promoting acute ischemic pain component exacerbate the continuous pain of<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s.<jats:styled-content style=\"fixed-case\">FBT<\/jats:styled-content>might be a powerful and feasible tool in early management of acute pain during<jats:styled-content style=\"fixed-case\">VOC<\/jats:styled-content>s in emergency departments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.12313","type":"journal-article","created":{"date-parts":[[2015,5,26]],"date-time":"2015-05-26T13:58:19Z","timestamp":1432648699000},"page":"680-687","source":"Crossref","is-referenced-by-count":16,"title":["Fentanyl Buccal Tablet: A New Breakthrough Pain Medication in Early Management of Severe Vaso\u2010Occlusive Crisis in Sickle Cell Disease"],"prefix":"10.1111","volume":"16","author":[{"given":"Lucia","family":"De Franceschi","sequence":"first","affiliation":[{"name":"Department of Medicine Section\u00a0of Internal Medicine University of Verona\u2010AOUI\u2010Verona Verona Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Mura","sequence":"additional","affiliation":[{"name":"Department of Medical Science \u201cM. 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