International Association for the Study of Pain®    IASP Press®

Progress in Pain Research and Management, Vol. 11
 Samir K. Ballas
1998, 398 pp, hardbound, ISBN 0-931092-22-1. Special Price: $40.00 
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Sickle cell disease, an inherited abnormality of hemoglobin, produces a variety of painful syndromes. The pain can be somatic, visceral, acute, chronic, persistent, or recurrent. This book reviews recent basic clinical phenomena and underlying disease mechanisms. Problems associated with sickle cell pain and approaches to its management are discussed in detail. This book will be useful to professionals who treat patients with sickle cell pain, including primary-care physicians, pain management specialists, hematologists, nurses, social workers, patient advocates, and house staff. Researchers interested in the patho-physiology of sickle cell pain will also find this book stimulating.

Table of Contents: Sickle Cell Pain

Basic Considerations

Sickle Cell Pain in Historical Perspective: history, nomenclature, definitions, unique features of sickle cell pain
Hematology of Sickle Cell Pain: A Prototype of Bedside and Bench Interaction. Classification of hemolytic anemias, signs and symptoms of hemolytic anemia, hematological features, hemoglobin structure and function, classification of hemoglobinopathies, sickle cell syndromes

Sickle Cell Pain Syndromes

Classification of Sickle Cell Pain: pathophysiologic classification, temporal classification, anatomic classification, classification by frequency and severity, etiologic classification, regional classification, illustrative case
The Acute Painful Episode: pathophysiology, predisposing factors, precipitating factors, clinical anatomy of the acute painful episode, illustrative cases
Acute Regional Pain Syndromes: craniofacial pain syndromes, long bones and joints, chest pain, low back pain syndrome, abdominal pain, genitourinary pain, muscle pain
Chronic Pain Syndromes: leg ulcers, avascular necrosis, chronic osteomyelitis, intractable painful episodes,chronic arthropathy secondary to iron deposition
Other Pain Syndromes: headache, migraine headache, neuropathic pain, fibromyalgia and myofascial pain, AIDS and sickle cell disease
Münchausen Sickle Cell Painful Episodes

Pharmacologic Therapy of Sickle Pain

Pharmacology of Analgesics and Adjuvants: pharmacodynamics and pharmacokinetics of analgesic drugs, nonopioid analgesics, opioid analgesics, adjuvants to analgesics, illustrative cases
Pharmacologic Management of the Patient with Sickle Cell Pain: pain assessment, outpatient management of sickle cell pain, pain management in the emergency department, management of sickle cell pain in the hospital, conclusions, illustrative cases

Alternatives to Pharmacologic Therapy

Nonpharmacologic Therapy of Sickle Cell Pain: classification of nonpharmacologic therapeutic modalities
New Therapeutic Modalities: primary molecular and cellular therapy, illustrative case, new approaches to analgesia

Miscellaneous Aspects of Sickle Cell Pain

The Adult "Difficult" Patient with Sickle Cell Disease: definition of terms pertinent to opioid use, characteristics of the "difficult" patient, management of the "difficult" patient, illustrative cases
Issues Pertinent to Sickle Cell Pain: patients’ rights, patients’ responsibilities, cost of care, barriers to quality care, patient advocacy, neglect by the medical profession at large, career and employment, litigation
Epilogue: disparity of focus between hematologists and patients, inappropriate management of sickle cell pain, lack of awareness in the ivory tower
Appendices: self-assessment questions and answers, abbreviations and acronyms, glossary


From molecular biology to clinical syndromes the erudition of the author is impressive. What is more striking is the compassion and empathy felt by a knowledgeable clinician who exhibits a deep understanding of the suffering and pain his patients may be going through.
This book will be of immense value in areas of the world where sickle cell anaemia and other combined forms of haemoglobinopathies ... are present.
The Journal of Tropical Diseases

All health providers who deal with sickle cell disease should find Sickle Cell Pain beneficial.
Overall, Sickle Cell Pain is an extremely useful textbook for health care personnel involved in the care of patients with sickle cell disease. It is difficult to identify a specific deficiency in the material provided and the way in which it is presented. The textbook should not be used as a quick reference for acute care management; it should be used by individuals interested in a more comprehensive understanding of sickle cell disease. Paediatrics & Child Health

Despite being primarily concerned with pain, the book also covers the clinical features of SCD and other medical emergencies such as "acute chest crisis". The chapters on pain management are excellent.
Although a haematologist, Dr Ballas undoubtedly talks the language with which any anaesthetist would instantly feel at home . . . The section on analgesic pharmacology is excellent, as are the sections dealing with non-pharmacological and new methods of treatment . . . Alternative therapies, hydroxyurea and bone marrow transplantation are given extensive coverage. Every section is referenced.
This book appears to be based on extensive practical experience with realistic observations on the therapeutic modalities available, backed up by a comprehensive review of the literature. The author does not shy away from the difficult issues surrounding the management of SCD pain. I think the book is ideal for any doctor who is likely to have significant exposure to patients with SCD whether they are haematologists, accident and emergency staff or specialist anaesthetists. As a monograph it makes a good read and should be viewed as such, rather than as a reference text. With a bit of luck it might lead to better and more generous prescribing for patients with SCD. British Journal of Anaesthesia
This monograph provides an up-to-date and comprehensive description not only of pain — a symptom that permeates every sphere of the existence of the afflicted patient — but also of the entire spectrum of sickle cell disease. We enjoyed reading this book because it is clearly written with a series of informative, well-illustrated and thoroughly referenced chapters presented in a logical sequence.
. . . the author has succeeded in producing a uniquely comprehensive monograph on sickle cell pain, all the more so because it is the product of a single clinician. The volume, the latest in a series of well-conceived timely monographs issued by the International Association for the Study of Pain (IASP), will help bridge the gap between bench research and bedside care and offers numerous insights to clinicians who participate in the care of ill-fated sufferers of this ruthless disease. Acute Pain

[ ] this handbook is an excellent review of the pathophysiology and treatment of pain and other acute and chronic complications in sickle cell disease. I am sure this affordable and concise yet remarkably complete book will become a precious resource for medical students, physicians, specialists, and other health-related professionals caring for sickle cell disease patients in the emergency room and in inpatient and outpatient settings. Moreover, the humanistic approach used by Dr. Ballas will help readers empathize better with their patients in pain. I definitely want to keep this handbook for my own use. Journal of Musculoskeletal Pain

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This page was updated on August 7, 2002