Ketorolac Versus Ibuprofen to Treat Painful Episodes of Sickle Cell Disease

Inclusion Criteria: * Confirmed diagnosis of any form of SCD, including sickle cell anemia, sickle-hemoglobin C disease, and sickle-ß˖ or ß°-thalassemia * Currently experiencing an acute painful episode (vaso-occlusive crisis), defined as acute pain in the extremities, back, abdomen, or chest that has lasted at least 4 hours and is presumed to be due to SCD, with no other identified cause * Onset of severe pain in its current location(s) must have occurred within 72 hours of study entry * Intensity of pain must be great enough to necessitate hospitalization for opioid analgesia (e.g., failure of home and outpatient therapy) * Ability to comprehend and use patient-controlled analgesia (PCA) * Score of 6 or greater on the baseline pain scale Exclusion Criteria: * Temperature greater than or equal to 38.5ºC at the time of study entry or in the preceding 12 hours * Has a new lobar pulmonary infiltrate or a diagnosis of acute chest syndrome (i.e., a new lobar pulmonary infiltrate and two or more of the following: temperature greater than 38ºC, tachypnea, dyspnea, intercostal or supraclavicular retractions, nasal flaring, chest wall pain, and an oxygen saturation of less than 90% in room air by pulse oximetry) * Diagnosis of acute splenic or hepatic sequestration crisis (i.e., liver or spleen enlarged from steady-state size and Hgb level decreased 2 g/dL or more from steady-state value) * Currently experiencing priapism * Pain caused by suspected or confirmed hepatobiliary disease (e.g., cholecystitis or cholelithiasis) * Chronic pain caused by suspected or confirmed aseptic or avascular necrosis of the femoral or humeral heads * Chronic pain syndrome characterized by opioid tolerance and defined by hospitalization for at least 30 days for the management of pain in a 1 year period prior to study entry * Current participation (last transfusion given within the 2 months prior to study entry) in a program of chronic transfusions for the management of SCD; the use of hydroxyurea alone is permitted * Allergy or history of anaphylactoid reactions to aspirin or other NSAIDs * Kidney dysfunction (i.e., serum creatinine concentration greater than 1.5 times the upper limit of normal for age) * History of gastrointestinal bleeding or ulceration requiring medical therapy * Concomitant bleeding disorder (e.g., von Willebrand disease, hemophilia, or a qualitative platelet defect) * Any other medical condition that would make it unsafe to receive NSAIDs, as determined by the study physician * PCA not preferred * Use of ketorolac in the 30 days prior to study entry * Use of scheduled (e.g., "around the clock") opioid analgesics in the 5 days before the onset of current acute painful crisis * Pregnant