Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of sickle-cell disease in children and adolescents
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In children and adolescents (aged 0–19 years) with sickle-cell disease (SCD), experiencing acute painful crises, the use of non-steroidal anti-inflammatory drugs (NSAIDs) is suggested for initial pain management.
Recommended in favor
Conditional
Certainty of evidence
Very low
Notes and Remarks
- The Guideline Development Group (GDG) noted uncertainty regarding the generalizability of evidence from intravenous (IV) ketorolac to oral NSAIDs. However, oral NSAIDs were considered a more feasible and accessible option, particularly in primary care settings where IV formulations may not be available.
- When NSAIDs alone are insufficient for managing moderate to severe acute pain, a stepwise approach may be used: starting with paracetamol plus NSAIDs, followed by escalation to opioids if pain remains uncontrolled.
- Health care providers should conduct individualized risk assessments and clearly explain the potential benefits and harms of NSAIDs versus opioids to the children, adolescents and their caregivers to support informed decision-making.
- IV opioids may be a reasonable option when intravenous (IV) NSAIDs are unavailable or when rapid pain relief is prioritized. Patients who prioritize immediate pain relief over concerns about opioidrelated side-effects may reasonably choose opioid analgesics for acute pain management.