Background and Methods The management of episodes of severepain in patients with sickle cell disease is a difficult clinicalproblem. We studied 36 children and adolescents with sicklecell disease who had 56 acute episodes of severe pain (44 in27 patients with sickle cell anemia, 8 in 7 patients with sicklecell-hemoglobin C disease, and 4 in 2 patients with sickle cell-+-thalassemia).The patients were randomly assigned in double-blind fashionto receive an intravenous infusion of either saline placeboor high-dose methylprednisolone (15 mg per kilogram of bodyweight, to a maximum of 1000 mg) on their admission to the hospitaland again 24 hours later. All the patients received intravenousmorphine sulfate until severe pain abated and were then givenacetaminophen with codeine.
Results For all episodes of pain, the duration of inpatientanalgesic therapy (intravenous and oral) was significantly shorterfor the patients who received methylprednisolone than for thosegiven placebo (mean, 41.3 vs. 71.3 hours; P = 0.030). The differencewas still significant (31.0 vs. 62.5 hours; P = 0.010) whenwe excluded seven episodes that were complicated by the chestsyndrome (three in the methylprednisolone group and four inthe placebo group). The patients who received methylprednisolonehad recurrent episodes of pain shortly after the discontinuationof therapy more often than did the patients receiving placebo.No adverse effects of methylprednisolone were observed.
Conclusions A short course of high-dose methylprednisolone decreasedthe duration of severe pain in children and adolescents withsickle cell disease, but patients who received methylprednisolonehad more rebound attacks after therapy was discontinued. Onbalance, corticosteroids are promising as an adjunct to supportivetherapy for painful episodes in children and adolescents withsickle cell disease.
Source Information
From the Division of Hematology-Oncology, Department of Pediatrics (T.C.G., G.R.B.), and the Academic Computing Center (D.M.), University of Texas Southwestern Medical Center at Dallas, and the Center for Cancer and Blood Disorders, Children's Medical Center, Dallas (T.C.G., G.R.B.).
Address reprint requests to Dr. Buchanan at the Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235-9063.
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+-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. 
