{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T00:04:12Z","timestamp":1790121852243,"version":"4.0.1"},"reference-count":32,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T00:00:00Z","timestamp":1627862400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["British Journal of Pain"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient\u2019s weight (&lt;50\u2009kg or &gt;50\u2009kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14\u201360\u2009years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600\u2009mcg (&gt;50\u2009kg) or 400\u2009mcg (&lt;50\u2009kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6\u2009hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32\u2009centimetres (cm) per hour (95% confidence interval (CI)\u2009=\u20090.20 to 0.44, p\u2009&lt;\u20090.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8\u2009cm (0\u20134.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.<\/jats:p>","DOI":"10.1177\/20494637211033814","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T02:21:47Z","timestamp":1627957307000},"page":"179-190","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["A non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell disease"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-9184","authenticated-orcid":false,"given":"Paul","family":"Telfer","sequence":"first","affiliation":[{"name":"Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK"},{"name":"Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Bestwick","sequence":"additional","affiliation":[{"name":"Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7665-5482","authenticated-orcid":false,"given":"James","family":"Elander","sequence":"additional","affiliation":[{"name":"School of Psychology, University of Derby, Derby, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arlene","family":"Osias","sequence":"additional","affiliation":[{"name":"Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nosheen","family":"Khalid","sequence":"additional","affiliation":[{"name":"Childrens Research Facility, Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imogen","family":"Skene","sequence":"additional","affiliation":[{"name":"Emergency Medicine Research Facility, Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben","family":"Nzouakou","sequence":"additional","affiliation":[{"name":"Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Challands","sequence":"additional","affiliation":[{"name":"Department of Anesthetics, Royal London Hospital, Barts Health NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filipa","family":"Barroso","sequence":"additional","affiliation":[{"name":"Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London 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