Letters

Management of sickle cell disease

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7135.935 (Published 21 March 1998) Cite this as: BMJ 1998;316:935

Non-addictive analgesics can be as effective as morphine and pethidine

  1. Yolande M Agble, Community nurse
  1. Greenford, Middlesex UB6 0SS
  2. Sickle-Watch (UK), West Indian Cultural Centre, London N8 0DT
  3. Northwick Park Hospital, Harrow, Middlesex HA1 3UJ
  4. Department of Obstetrics and Gynaecology and Reproductive Health Care, University of Manchester, Palatine Centre, Manchester M20 3LJ
  5. Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston 7, Jamaica
  6. Imperial College School of Medicine, Central Middlesex Hospital, London NW10 7NS

    EDITOR—I am concerned at the increasing use of pethidine and morphine analgesia in young African and Afro-Caribbean children with sickle cell anaemia, as described by Fertleman et al and by Davies and Oni. 1 2 I am astonished that a vulnerable section of the community is being given addictive drugs when non-addictive analgesics would be just as effective, particularly in a society where drug addiction among young people is recognised as a problem.

    I have nursed patients with sickle cell disease in Trinidad and in Ghana, where the numbers of sufferers are much larger than those found in the United Kingdom. Education of parents and children by public health nurses in schools and in the community about their condition, regular follow up by clinicians, and admission when in crisis, with paracetamol being given alone or in combination with codeine when something stronger is required, went a long way to ensuring a normal existence for such children. I remember only one occasion when pethidine was used, and that was given in a small dose to a patient in labour. More recently pethidine has been used in small doses in the Caribbean, but never morphine—for obvious reasons. I am baffled why children here should need it.

    The claim that parents and children are demanding opiates for pain control shows a lack of education and knowledge about the illness and the long term effect of such drugs on their part. I have come across several young addicts in hospitals across London, and I wonder how long it will be before they end up in a criminal situation.

    References

    1. 1.
    2. 2.

    Management would improve if doctors listened more to patients

    1. Neville Clare, Director
    1. Greenford, Middlesex UB6 0SS
    2. Sickle-Watch (UK), West Indian Cultural Centre, London N8 0DT
    3. Northwick Park Hospital, Harrow, Middlesex HA1 3UJ
    4. Department of Obstetrics and Gynaecology and Reproductive Health Care, University of Manchester, Palatine Centre, Manchester M20 3LJ
    5. Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston 7, Jamaica
    6. Imperial College School of Medicine, Central Middlesex Hospital, London NW10 7NS

      EDITOR—As a 51 year old patient with heterozygous sickle cell anaemia and a national campaigner for improved services in hospitals since 1974, I note that pethidine has been discounted for morphine infusions in the review article …

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