By Suleiman Tajudeen
CITIZENS COMPASS – Sickle cell anaemia is a disorder of the blood that occurs when haemoglobin variant Hs gene is inherited from both parents. People living with sickle cell anaemia are mostly giving birth to by parents that are living with sickle cell anaemia (HbSS) or when Hbs, Hb, Sc, or Sickle Beta thalassaemia is inherited from either of the parents. It is important to note that haemoglobin SS is the most common and more affected with crises.
Generally, people living with sickle cell disorders are presented with crises which range from pain, jaundice, leg ulcer, priapism and other variant conditions. Pain on the other hand is an unpleasant sensation usually caused by noxious stimulation of sensory nerve endings. Similarly, pain could be defined as a state in which severe discomfort or an unpleasant sensation is experienced and signaled by the following: verbal and non verbal communication including self protecting behaviour, narrowed attention focus evidenced by altered time perspective, social withdrawal or impaired thought process distracting behaviour such as moaning, crying, pacing, restlessness, beaten appearance, scattered facial movement etc. (Anie et al 2002,Kato 2017,Rees& Gibson 2017).
Sickle cell painful crises are undoubtedly difficult to manage hence, the clinician or the therapist must be careful in order not to contribute to narcotic addiction. Experiences have shown that because of the persistent complaints about painful crises, the clinician or therapist tends to give all sorts of pain relief medicine to reduce the pain experienced by patients ,hence the patients now become addicted to the prescribed medicine which has no other name than drug abuse.
Sickle cell painful crises are thought to result from transient episodes of microvascular congestion, tissue ischemia, and the release of inflammatory mediators. The pain associated with sickle cell crises could be excruciating (intensely painful). Sickle cell painful crises is tagged Aromolegun in the Yoruba culture while the Igbo will describe it as okpukpu mgbu (bone pain). The description of the above painful condition in Nigerian culture is to tell us how severe sickle cell pain is experienced in our culture.
In the psychiatric unit of Lagos University Teaching Hospital (LUTH), Lagos. There are some occasions where patients were admitted, based on abuse of prescribed medicine (ie.Pentazocine and other pain relief medicine). It is important to note that when such patient is admitted he or she must go through the same treatment that other substance abusers go through because of their addictive behaviour. Based on the above assertion, the clinician must be able to distinguish between the patient in sickle cell painful crises who needs aggressive pain treatment and the addict that will tend to abuse the medicine prescribed for their treatment.
To differentiate between both, it must be collaborative efforts by multidisciplinary teams that should include: specialists in haematology, pain management, addictive medicine, psychology/? psychiatry to achieve good results. The major treatment for painful crises are painkiller medicine like tablets, capsules, injectable drugs and at times fluid etc.
Psychological approach
Psychological treatment is all about using psychological methods to treat painful crises in Sickle Cell Disorder. It could be used in adjuncts to other forms of treatment and could be used to reduce the over reliance on drug therapy which at times leads to the abuse of the medicine prescribed by the clinician. It is important to note that the ability to withstand painful experience differs from one individual to the other hence their coping capability. People that have strong threshold for handling painful experiences are able to cope with their work and other social responsibility while the reverse is the case with those that have weak threshold for handling their pain.
Some of the evidences include;
Psycho- education: The nature of sickle cell disorder needs to be adequately explained to the client/patient and some of the coping strategies that need to put in place for effective management (i.e. the use of regular medication like folic acid, B complex, paludrine tab, intake of fluid regularly and also the knowledge of the do’s and don’ts of sickle cell condition). Psycho education should also be organised through group psychotherapy sessions, where people of similar condition share ideas and knowledge about sickle cell conditions. Anie et al (2003,2005) asserted that group interventions have helped to identify issues and concerns in children and adolescents living with sickle cell disorder. Generally, there are different types of painkillers which include the following…
To be continued..
Dr Suleiman Tajudeen is a Director, Clinical Psychology at Lagos University Teaching Hospital (LUTH).
