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Randomized Controlled Trial Multicenter Study Journal Article Ppublish 23 citations

PubMed: 37733479 DOI: 10.1097/j.pain.0000000000003009

A cognitive-behavioral digital health intervention for sickle cell disease pain in adolescents: a randomized, controlled, multicenter trial.

Pain 165(1):164-176

Authors: Tonya M Palermo, Chitra Lalloo, Chuan Zhou, Carlton Dampier, William Zempsky, Sherif M Badawy, Nitya Bakshi, Yeon Joo Ko, Fareha Nishat, Jennifer N Stinson

Affiliations

  • Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA, United States.
  • Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.
  • Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
  • Institute for Health Policy, Management and Evaluation, University of Toronto, ON, Canada.
  • Department of Pediatrics, University of Washington, Seattle, WA, United States.
  • Division of Pediatric Hematology/Oncology/Blood and Marrow Transplant, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States.
  • Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, United States.
  • Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Department of Pediatrics, University of Connecticut School of Medicine, Hartford, CT, United States.
  • Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
  • Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children's Hospital of Chicago, Chicago, IL, United States.
  • Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.

Abstract

Severe acute and chronic pain are the most common complications of sickle cell disease (SCD). Pain results in disability, psychosocial distress, repeated clinic visits/hospitalizations, and significant healthcare costs. Psychosocial pain interventions that teach cognitive and behavioral strategies for managing pain have been effective in other adolescent populations when delivered in person or through digital technologies. Our aim was to conduct a multisite, randomized, controlled trial to improve pain and coping in youth aged 12 to 18 years with SCD using a digital cognitive-behavioral therapy program (iCanCope with Sickle Cell Disease; iCC-SCD) vs Education control. We enrolled 137 participants (ages 12-18 years, 59% female) and analyzed 111 adolescents (107 caregivers), 54 randomized to Education control and 57 randomized to iCC-SCD. Ninety-two percent of youth completed posttreatment assessments and 88% completed 6-month follow-up. There was a significant effect of treatment group (iCC-SCD vs Education) on reduction in average pain intensity from baseline to 6-month follow-up (b = -1.32, P = 0.009, 95% CI [-2.29, -0.34], d = 0.50), and for the number of days with pain, adolescents in the iCC-SCD group demonstrated fewer pain days compared with the Education group at 6-month follow-up (incident rate ratio = 0.63, P = 0.006, 95% CI [0.30, 0.95], d = 0.53). Treatment effects were also found for coping attempts, momentary mood, and fatigue. Several secondary outcomes did not change with intervention, including anxiety, depression, pain interference, and global impression of change. Future studies are needed to identify effective implementation strategies to bring evidence-based cognitive-behavioral therapy for sickle cell pain to SCD clinics and communities.

MeSH

Cells, Anemia, Sickle Cell, Pain, Adolescent, Therapeutics, Digital Health

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