In Reply.—Dr Mallouh may have misinterpreted several aspects of our recent article on intravenous narcotic therapy for severe vaso-occlusive crises in children with sickle cell anemia.
We feel that a physician treating a patient with a vaso-occlusive crisis should attempt to provide effective analgesia, irrespective of the specific pain threshold. If the patient appears to be (and states that he or she is) in severe pain, then a potent analgesic regimen, such as that described in our article, should be used.
We did not indicate that the pain of sickle cell crisis is similar to that of the postoperative period and terminal malignancy. Our intent was to refer to the fact that the only previous studies of intravenous narcotic therapy in children were in those clinical settings. We agree that the character of pain is quite different in a sickle cell crisis. Our quotation of textbooks about narcotic use