A small but increasing percentage of patients spend from one quarter to two-thirds of a year in hospital based out-patient and in-patient care seeking treatment for pain. In 1990, 43 patients accounted for 57% of the painful events and 91% of the total hospital days. Through the assessment of attributes of the patients, and of their pain and their response to therapies, we aim to determine psychological and biological patterns in sickle cell patients who experience frequently recurring acute painful episodes and high utilization of hospital based facilities. More specifically, the areas are to identify the common features of the high utilizer group and distinguishing biopsychosocial risk factors in the progression of pain. A series of surveys and studies will be performed to determine the impact of individualized aggressive narcotic and non-narcotic treatment strategies on objective health care parameters used to define high utilizers, such as, number of crisis, total hospitalization days and length of stay, aggressive rapid dose titration to pain relief and slow tapering of narcotic analgesics to prevent or lessen recidivism and patient controlled (PCA) titrations of parenteral non-narcotics will be compared to standard agent Morphine or its narcotic equivalent in the treatment of acute painful episodes employing standard designs for group analysis and single patient design to ascertain effects in high utilizers. It is anticipated that as a result of these studies, comprehensive protocols will be developed which will ameliorate or prevent the high utilizer state as it relates to inadequate assessment and poor pain management strategies.
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