Management of Sickle Cell Pain

Wally R. Smith, MD, Florence Neal Cooper Smith Professor Sickle Cell Disease at Virginia Commonwealth University Health, and Medical Director of the VCU Adult Sickle Cell Medical Home, is a world authority on pain in sickle cell disease, and Executive Editor of the Journal of Sickle Cell Disease, published by Oxford University Press. He attended medical school at University of Alabama Heersink School of Medicine, and finished residency in Internal Medicine at the University of Tennessee. Thokozeni Lipato, MD, is a general internist specializing in Sickle Cell Disease at Virginia Commonwealth University Health. He is an Assistant Professor of Internal Medicine at the Virginia Commonwealth University School of Medicine. He attended medical school at University of Alabama Heersink School of Medicine, and Internal Medicine resident at the University of Minnesota.

• 1. How can I lessen the interference of my patient's pain with their schoolwork? 2. Why is my adolescent's pain continually getting worse? 3. How do I manage my adolescent who wants to go back to the pediatrician for pain management? 4. How do I manage my new patient who has been erratically managed with opioids? 5. Does my adult patient on de facto chronic opioid therapy need it? 6. Why is my young adult patient increasing Emergency Department visits and opioid use? 7. How do I manage my adult patient at home in a vaso-occlusive crisis? 8. How do I manage my adult patient in the Emergency Department or infusion center in a vaso-occlusive crisis? 9. How do I manage my adult patient in the hospital in a vaso-occlusive crisis? 10. How do I manage my patient in the hospital with intractable pain? 11. How do I respond when my patient complains about their pain management by others? 12. How do I manage my patient's depression and/or anxiety? 13. How do I manage my sickle cell pain patient's sleep problems? 14. How do I reduce my patient's constant reliance on the Emergency Department? 15. How do I reduce my patient's psychic trauma and social disruption? 16. What do I do when my patient with anxiety self-medicates with marijuana? 17. How do I respond when my patient comes to the clinic asking for more opioids than usual? 18. Why are chronic opioids not working for my patient's pain? 19. How do I manage my patient on high doses of chronic opioids who continues high Emergency Department use? 20. What do I do when my patient is accused of selling their opioids? 21. How do I manage my patient on chronic opioid therapy and benzodiazepines? 22. How do I manage my patient using cannabis for pain?23. How do I manage my patient with severe pain from acute, recurrent priapism?24. How do I manage my patient with disabling pain in the hip and leg?25. How do I manage my patient with a painful leg ulcer? 26. How do I manage my patients' constant need for prior authorizations, or out of pocket medication costs?