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

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.

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Publication Details

Journal
Blood Advances
Published
2024-10-07
DOI
https://doi.org/10.1182/bloodadvances.2024013861
Citations
13
Primary Topic
Hemoglobinopathies and Related Disorders
Type
article
Field-Weighted Citation Impact
5.69

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article

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

Kaleab Z. Abebe, Victor R. Gordeuk, Christina M. Lalama, Charles R. Jonassaint et al.
13 citations
Blood Advances
Hemoglobinopathies and Related Disorders
5.69
article

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

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

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.

Blood AdvancesVol. 8(24)
Northwestern University (US), Lurie Children's Hospital (US), Seattle Children's Hospital (US), Bloomberg (United States) (US), Johns Hopkins University (US), Thomas Jefferson University (US), Savannah State University (US), University of Pittsburgh (US), Duke University (US), University of Toronto (CA), East Carolina University (US), Vanderbilt University (US), Thomas Jefferson University Hospital (US), Johns Hopkins Medicine (US), Hospital for Sick Children (CA), University of Illinois Chicago (US), Georgia Southern University (US), University of Chicago (US), Behavioral Pharma (United States) (US), Seattle Children's Hospital (US), Lurie Children's Hospital (US), Clinical Research Consortium (US), Institute for Clinical Evaluative Sciences (CA), Institute for Work & Health (CA), Cell Medica (Switzerland) (CH), Pittsburg State University (US), The Ohio State University (US)
Patient-Centered Outcomes Research Institute, National Institute of Nursing Research, H2020 European Research Council
Quality Education
Openalex Percentile: Top 3%
Hemoglobinopathies and Related Disorders
5.69
DOIOpen Access PDFOpenAlex
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