Self-Administered Acupressure Improves Pain and Quality of Life in Patients with Sickle Cell Disease

Background: Sickle Cell Disease (SCD) is a genetic blood disorder that predominantly affects people of black descent. Individuals with SCD often experience chronic pain and recurrent vaso-occlusive crises (VOCs), requiring frequent hospitalization. The administration of high doses of opioids remains the primary therapy, increasing the risks of tolerance, opioid-induced hyperalgesia, and overall reduced quality of life (QoL). However, due to impediments to accessing healthcare, approximately 51-79% of patients with SCD manage their VOCs at home (Zaidi et al., Orphanet J Rare Dis 2021). Developing safe, effective, low-cost approaches to address this unmet need for VOCs care is urgently needed. Acupressure is a non-opioid alternative therapeutic intervention involving the application of pressure to specific pressure points, also known as acupoints, using fingers or other devices. The feasibility and efficacy of acupressure have been studied in several clinical pain populations, such as cancer survivors (Harris et al., JAMA Oncol 2016), individuals with knee osteoarthritis (Harris et al., Arthritis Care Res (Hoboken) 2018), and individuals with lower back pain (Harris et al., Pain Med 2019), which demonstrated the impacts of acupressure in reducing pain, fatigue, and other symptoms. We aim to evaluate the feasibility and effectiveness of self-administered acupressure in pain and other clinical symptoms associated with SCD. Methods: A total of 21 SCD participants (15 from Indiana and 6 from California) were enrolled in the acupressure arm of our study with a retention rate of 86% (n=1 loss-to-follow-up and n=2 drop-out). Eighteen participants (aged 13-48, consisting of 14 females) self-administered the acupressure treatments every other day for five weeks, using a subset of acupoints from our ongoing acupuncture randomized controlled trial (NCT05045820) (Barrett et al., Blood 2022). Pain intensity and interference, physical dysfunction, anxiety, and depression were assessed using PROMIS-29. The Widespread Pain Index measured the spatial distribution of pain across the body. Sleep quality and fatigue were measured using the Pittsburgh Sleep Quality Index and the Multidimensional Fatigue Inventory, respectively. SCD pain-related QoL was evaluated with the Pediatric Quality of Life Inventory (PedsQLTM) SCD module (higher scores of PedsQL represent better QoL). A paired two-sample t-test (two-tailed) was used to analyze the changes from baseline to post-treatment. Results: Significant patient-reported symptom improvements were observed. A reduction represented by a change in score following the treatment in pain intensity (-2.882 ± 1.536, p<0.0001 vs. baseline), pain interference (-7.0 ± 4.123, p<0.0001 vs. baseline), and the number of painful sites (-3.143 ± 2.538, p=0.0005 vs. baseline) was noted following acupressure. In addition, significant improvements were also observed in anxiety (-2.588 ± 2.763, p=0.0014 vs. baseline), depression (-2.412 ± 2.647, p=0.0017 vs. baseline), physical dysfunction (-2.647 ± 2.978, p=0.0021 vs. baseline), sleep quality (-1.595 ± 2.739, p=0.0244 vs. baseline), fatigue (-15.45 ± 11.56, p=0.0001 vs. baseline), as well as pain-related QoL (11.8 ± 10.42, p=0.001 vs. baseline). Conclusion: These preliminary data suggest that self-administered acupressure at home-based setting may be an effective treatment for improving pain and associated symptoms experienced by patients with SCD. Further research, including a control group and a larger sample size, is needed to validate the clinical outcomes of acupressure in more SCD patients.