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increasing awareness about SCD and promoting patient education, health care professionals can help patients

and their families cope with SCD and better manage the associated pain. Recurring episodes of acute and/or

severe pain are hallmarks of SCD. SCD pain can often be debilitating, and episodes of pain vary from patient to

patient in both frequency and intensity. SCD pain can be classified as acute, chronic, or mixed. At some point,

most SCD patients experience episodes of pain often referred to as vaso-occlusive crisis (sickle cell crisis), the

duration of which may range from hours to days. Some patients seldom have a sickle cell crisis, while others

may experience crises several times a year. Some episodes may be so severe that hospitalization is warranted

to manage the pain. An acute pain event is the most common type of pain, and the onset is typically abrupt. It is

often the result of an ischemic tissue injury, which is due to the occlusion of microvascular beds by sickled

erythrocytes during an acute crisis. Acute pain episodes can also be triggered by factors including extreme

temperature changes, changes in altitude, physical and emotional stress, illnesses, infections, dehydration, cold

climates, menstruation, and fatigue. Chronic pain is pain that lasts for 3 to 6 months or longer. Chronic pain

often results from the destruction of bones, joints, and visceral organs due to recurrent crises. Sources of

chronic sickle cell pain include aseptic necrosis, leg ulcerations, and osteomyelitis. Unfortunately, acute and

chronic pain associated with SCD are commonly undertreated or inappropriately managed due to patient fear of

potential addiction and adverse effects. Many studies report that some health care professionals are also

concerned about the potential for addiction. When appropriate, pharmacologic management of SCD pain may

involve the use of 3 major pharmacologic classes: nonopioids, opioids, and adjuvants.

Out of this group, which of the following demographic is the LEAST likely to have SCD?

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