Management of Acute Pain Crisis in Adult of Sickle Cell Disease: A Narrative Review

Sickle cell disease (SCD) is a genetic disorder characterized by rigid, sickle-shaped red blood cells, leading to complications such as vaso-occlusive crises (VOCs). These acute pain episodes are the most common reason for emergency visits and hospitalizations in adults with SCD. his narrative review evaluated the efficacy of pharmacological and non-pharmacological treatments for acute pain crises in adults with SCD, with secondary attention to safety outcomes, including side effects, treatment duration, hospital stay, and readmission rates. Materials and Methods: A literature search was conducted in PubMed, Cochrane Library, and Google Scholar up to August 20, 2024, focusing on randomized controlled trials (RCTs) in English involving adult patients. Relevant studies were reviewed, and findings were synthesized narratively. The result Twelve RCTs involving 576 adults were included. Most studies were of good quality, though two had high risk and two had unclear risk of bias. Interventions included L-glutamine, pregabalin, regadenoson, ketorolac, individualized opioid protocols, progressive muscle relaxation, and music therapy. L-glutamine and individualized opioid protocols consistently reduced pain intensity. Pregabalin and ketorolac showed mixed results, while non-pharmacological interventions provided modest pain relief or improved mood. Overall, individualized treatment approaches appeared more effective than uniform protocols, though variability in study design and outcomes limits generalizability. IIn conclusion Twelve RCTs involving 576 adults were included. Most studies were of good quality, though two had high risk and two had unclear risk of bias. Interventions included L-glutamine, pregabalin, regadenoson, ketorolac, individualized opioid protocols, progressive muscle relaxation, and music therapy. L-glutamine and individualized opioid protocols consistently reduced pain intensity. Pregabalin and ketorolac showed mixed results, while non-pharmacological interventions provided modest pain relief or improved mood. Overall, individualized treatment approaches appeared more effective than uniform protocols, though variability in study design and outcomes limits generalizability. TEK therapy and L-glutamine were most effective for pain reduction, while pregabalin and regadenoson were safe and promising. Non-pharmacological interventions may support standard care, but further high-quality RCTs are recommended to confirm efficacy and safety.