BETHESDA, MD. — Children with sickle cell disease who were hospitalized for frequent recurrent painful episodes were given significantly less than the prescribed amount of morphine, Eufemia Jacob, Ph.D., reported in a poster presented at a meeting sponsored by the National Institutes of Health's Pain Consortium.
The mean dosages delivered during prolonged hospitalizations were 0.5–1.5 mg/kg per day, which represented, on average, only 37% of the prescribed amount of morphine. The prescribed amount consisted of a lower-than-recommended “background” infusion and additional higher doses the patients could get by pressing a button. Dr. Jacob and her colleagues concluded that the children were given “suboptimal” regimens, but she cautioned that “suboptimal” does not necessarily mean “undertreatment.”
Dr. Jacob of the department of pediatrics at Baylor College of Medicine, Houston, offered several possible reasons for the observed dosage difference: Children might not have pushed the button because they were asleep or too exhausted from the pain, did not like the side effects, or might not have understood the self-delivery system. The inherent processes involved in the biology of sickle cell disease may not be responsive to morphine. She is currently conducting a study to compare different methods of programming the morphine delivery system and to assess the contributions of genes and other biology markers. She hopes to customize regimens to shorten hospital stays for acute, painful episodes in patients with sickle cell disease.