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High-dose intravenous methylprednisolone therapy for pain in children and adolescents with sickle cell disease.
N Engl J Med. 1994 Mar 17; 330(11):733-7.NEJM

Abstract

BACKGROUND AND METHODS

The management of episodes of severe pain in patients with sickle cell disease is a difficult clinical problem. We studied 36 children and adolescents with sickle cell disease who had 56 acute episodes of severe pain (44 in 27 patients with sickle cell anemia, 8 in 7 patients with sickle cell-hemoglobin C disease, and 4 in 2 patients with sickle cell-beta (+)-thalassemia). The patients were randomly assigned in double-blind fashion to receive an intravenous infusion of either saline placebo or high-dose methylprednisolone (15 mg per kilogram of body weight, to a maximum of 1000 mg) on their admission to the hospital and again 24 hours later. All the patients received intravenous morphine sulfate until severe pain abated and were then given acetaminophen with codeine.

RESULTS

For all episodes of pain, the duration of inpatient analgesic therapy (intravenous and oral) was significantly shorter for the patients who received methylprednisolone than for those given placebo (mean, 41.3 vs 71.3 hours; P = 0.030). The difference was still significant (31.0 vs. 62.5 hours; P = 0.010) when we excluded seven episodes that were complicated by the chest syndrome (three in the methylprednisolone group and four in the placebo group). The patients who received methylprednisolone had recurrent episodes of pain shortly after the discontinuation of therapy more often than did the patients receiving placebo. No adverse effects of methylprednisolone were observed.

CONCLUSIONS

A short course of high-dose methylprednisolone decreased the duration of severe pain in children and adolescents with sickle cell disease, but patients who received methylprednisolone had more rebound attacks after therapy was discontinued. On balance, corticosteroids are promising as an adjunct to supportive therapy for painful episodes in children and adolescents with sickle cell disease.

Authors+Show Affiliations

Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas 75235-9063.No affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8107739

Citation

Griffin, T C., et al. "High-dose Intravenous Methylprednisolone Therapy for Pain in Children and Adolescents With Sickle Cell Disease." The New England Journal of Medicine, vol. 330, no. 11, 1994, pp. 733-7.
Griffin TC, McIntire D, Buchanan GR. High-dose intravenous methylprednisolone therapy for pain in children and adolescents with sickle cell disease. N Engl J Med. 1994;330(11):733-7.
Griffin, T. C., McIntire, D., & Buchanan, G. R. (1994). High-dose intravenous methylprednisolone therapy for pain in children and adolescents with sickle cell disease. The New England Journal of Medicine, 330(11), 733-7.
Griffin TC, McIntire D, Buchanan GR. High-dose Intravenous Methylprednisolone Therapy for Pain in Children and Adolescents With Sickle Cell Disease. N Engl J Med. 1994 Mar 17;330(11):733-7. PubMed PMID: 8107739.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-dose intravenous methylprednisolone therapy for pain in children and adolescents with sickle cell disease. AU - Griffin,T C, AU - McIntire,D, AU - Buchanan,G R, PY - 1994/3/17/pubmed PY - 1994/3/17/medline PY - 1994/3/17/entrez SP - 733 EP - 7 JF - The New England journal of medicine JO - N Engl J Med VL - 330 IS - 11 N2 - BACKGROUND AND METHODS: The management of episodes of severe pain in patients with sickle cell disease is a difficult clinical problem. We studied 36 children and adolescents with sickle cell disease who had 56 acute episodes of severe pain (44 in 27 patients with sickle cell anemia, 8 in 7 patients with sickle cell-hemoglobin C disease, and 4 in 2 patients with sickle cell-beta (+)-thalassemia). The patients were randomly assigned in double-blind fashion to receive an intravenous infusion of either saline placebo or high-dose methylprednisolone (15 mg per kilogram of body weight, to a maximum of 1000 mg) on their admission to the hospital and again 24 hours later. All the patients received intravenous morphine sulfate until severe pain abated and were then given acetaminophen with codeine. RESULTS: For all episodes of pain, the duration of inpatient analgesic therapy (intravenous and oral) was significantly shorter for the patients who received methylprednisolone than for those given placebo (mean, 41.3 vs 71.3 hours; P = 0.030). The difference was still significant (31.0 vs. 62.5 hours; P = 0.010) when we excluded seven episodes that were complicated by the chest syndrome (three in the methylprednisolone group and four in the placebo group). The patients who received methylprednisolone had recurrent episodes of pain shortly after the discontinuation of therapy more often than did the patients receiving placebo. No adverse effects of methylprednisolone were observed. CONCLUSIONS: A short course of high-dose methylprednisolone decreased the duration of severe pain in children and adolescents with sickle cell disease, but patients who received methylprednisolone had more rebound attacks after therapy was discontinued. On balance, corticosteroids are promising as an adjunct to supportive therapy for painful episodes in children and adolescents with sickle cell disease. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/8107739/High_dose_intravenous_methylprednisolone_therapy_for_pain_in_children_and_adolescents_with_sickle_cell_disease_ L2 - https://www.nejm.org/doi/10.1056/NEJM199403173301101?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -