In Reply.—I also believe that effective analgesia should be provided for patients with painful occlusive crises of sickle cell disease. Dr Holman states that nonsteroidal anti-inflammatory agents appear to be quite specific for bone-induced pain and that a combination of drugs may be necessary. Nevertheless, he recommends oral morphine therapy for "significant" pain.
Dr Holman also minimizes the possibility of drug addiction. Dr Buchanan,1 in his reply to my previous letter, stated that "no data have been published in the literature showing that intermittent and carefully supervised high-dose narcotic therapy for severe painful crisis predisposes to drug dependency or addiction." However, he does not mention that there are no studies to the contrary.
My problem is the definition of severe as used by Dr Buchanan and significant as used by Dr Holman. Several patients have been seen in my clinic with what seemed to be severe pain, yet