The most appropriate pain regimen for this patient is scheduled morphine. Pain is the most common complication of sickle cell disease (SCD) and may be the initial presenting symptom in patients who subsequently develop more severe complications, such as acute chest syndrome (ACS) or multiorgan failure. Patients commonly have musculoskeletal symptoms, but vaso-occlusion can occur in any organ system. No reliable physical or laboratory findings serve as useful surrogate markers for excluding vaso-occlusion; therefore, managing a painful episode in SCD is based on symptoms. Management of an uncomplicated painful episode includes hydration, nonopioid and opioid analgesia, and incentive spirometry to avoid ACS. Morphine and hydromorphone are the opioid analgesics of choice. During hospitalization, opioid analgesia is most effectively delivered by regularly scheduled opioid administration or by patient-controlled analgesia pumps that include a basal rate and a demand option.

Meperidine is generally avoided because of its short half-life and lowered seizure threshold.

NSAIDs such as ketoprofen may be useful in the outpatient management of a painful vaso-occlusive crisis in patients with stable kidney function, but are probably inadequate as single agents for patients with severe pain requiring hospitalization. In addition, randomized studies have demonstrated no benefit of adding an NSAID to an opioid for the treatment of acute vaso-occlusive crisis in hospitalized patients.