Multimodal Analgesia with Acupuncture in Sickle Cell Crisis: A Case Report

Case Diagnosis: A 22-year-old man with sickle cell anemia, status post–splenectomy for acute chest syndrome, right humeral head avascular necrosis, and asthma presenting for sickle cell crisis.

Case Description or Program Description: The patient presented with worsening back, bilateral leg, and mild chest pain, consistent with a sickle cell crisis. His initial workup revealed leukocytosis and anemia, with no acute cardiopulmonary abnormalities on chest x-ray. At outside hospital, he received IV fluids, ketorolac, Dilaudid, and Benadryl. Preferring care closer to home, he later transferred to our hospital where his pain regimen over 24 hours included Toradol 15 mg IV (four times), Benadryl 25 mg IV (four times), Dilaudid 4 mg (three times), and a Morphine PCA delivering approximately 197.7 mg in 24 hours.

Setting: Tertiary care hospital.

Assessment/Results: Despite multimodal pharmacologic management, his pain remained significant in the lower back, chest wall, and legs. To enhance pain control, acupuncture was incorporated as an adjunct. After obtaining informed consent, JAAP (Jain Auricular Acupuncture protocol) using Pyonex needles was performed targeting Shen Men and additional auricular points for pain modulation. The 12-minute session reduced his pain score from 7/10 to 5/10 without any complications.

Discussion (relevance): This case highlights the challenges of managing acute-on-chronic pain in sickle cell crisis amidst multiple comorbidities. Conventional multimodal analgesia, including opioids and NSAIDs, did not fully control patient’s pain. The addition of acupuncture provided additional analgesic benefits and improved comfort, suggesting a valuable role for non-pharmacologic interventions in a comprehensive pain management strategy for sickle cell disease. Further research is warranted to validate the efficacy of acupuncture in this patient population.

Conclusions: Non-pharmacologic interventions such as acupuncture should be furthered explored and considered in the pain management of patients with acute sickle cell crisis as these interventions may provide analgesic benefits and improve comfort in this patient population.