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Journal Article Randomized Controlled Trial Multicenter Study Ppublish 12 citations

PubMed: 39374587 DOI: 10.1182/bloodadvances.2024013861

Digital cognitive behavioral therapy vs education for pain in adults with sickle cell disease.

Blood Adv 8(24):6257-6266

Authors: Charles R Jonassaint, Christina M Lalama, C Patrick Carroll, Sherif M Badawy, Megan E Hamm, Jennifer N Stinson, Chitra Lalloo, Santosh L Saraf, Victor R Gordeuk, Robert M Cronin, Nirmish Shah, Sophie M Lanzkron, Darla Liles, Julia A O'Brien, Cassandra Trimnell, Lakiea Bailey, Raymona H Lawrence, Leshana Saint Jean, Michael DeBaun, Laura M De Castro, Tonya M Palermo, Kaleab Z Abebe

Affiliations

  • Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
  • Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins University School of Medicine, Baltimore, MD.
  • Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
  • Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
  • Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
  • Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada.
  • Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
  • Department of Medicine, Sickle Cell Center, University of Illinois Chicago, Chicago, IL.
  • Department of Internal Medicine, The Ohio State University, Columbus, OH.
  • Division of Hematology-Oncology, Department of Pediatrics, Sickle Cell Transition Intervention, Duke University, Durham, NC.
  • Department of Medicine, Sidney Kimmel College of Medicine, Thomas Jefferson University.
  • Department of Internal Medicine, East Carolina University, Greenville, NC.
  • Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, Pittsburgh, PA.
  • Sickle Cell 101, San Jose, CA.
  • Sickle Cell Community Consortium, Atlanta, GA.
  • Jiann Ping Hsu College of Public Health, Georgia Southern University, Savannah, GA.
  • School of Medicine, Vanderbilt University, Nashville, TN.
  • Department of Anesthesiology & Pain Medicine, University of Washington and Seattle Children's Research Institute, Seattle, WA.

Abstract

Despite the burden of chronic pain in sickle cell disease (SCD), nonpharmacological approaches remain limited. This multisite, randomized trial compared digital cognitive behavioral therapy (CBT) with a digital pain/SCD education program ("Education") for managing pain and related symptoms. Participants were recruited virtually from seven SCD centers and community organizations in the United States. Adults (aged ≥18 years) with SCD-related chronic pain and/or daily opioid use were assigned to receive either CBT or Education for 12 weeks. Both groups used an app with interactive chatbot lessons and received personalized health coach support. The primary outcome was the change in pain interference at six months, with secondary outcomes including pain intensity, depression, anxiety, quality of life, and self-efficacy. Of 453 screened participants, 359 (79%) were randomized to CBT (n = 181) or Education (n = 178); 92% were Black African American, and 66.3% were female. At six months, 250 participants (70%) completed follow-up assessments, with 16 (4%) withdrawals. Engagement with the chatbot varied, with 76% connecting and 48% completing at least one lesson, but 80% of participants completed at least one health coach session. Both groups showed significant within-group improvements in pain interference (CBT: -2.13; Education: -2.66), but no significant difference was observed between them (mean difference, 0.54; P = .57). There were no between-group differences in pain intensity, depression, anxiety, or quality of life. High engagement with health coaching and variable engagement with digital components may explain the similar outcomes between interventions in this diverse, hard-to-reach population.

MeSH

Depression, Cells, Quality Of Life, Chronic Pain, Anemia, Sickle Cell, Pain, Therapeutics, Education, Hematologic Diseases, Cognitive Behavioral Therapy

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