Preliminary evaluation of the clinical implementation of cognitive-behavioral therapy for chronic pain management in pediatric sickle cell disease

• Authors: Soumitri Sil, Emory University; Kristina Lai, Childrens Healthcare Atlanta; Jennifer Lee, Emory University; Jordan Marchak, Emory University; Beth Thompson, Emory University; Lindsey Cohen, Childrens Healthcare Atlanta; Peter Lane Jr, Emory University; Carlton Dampier, Emory University
• Journal Title: COMPLEMENTARY THERAPIES IN MEDICINE
• Volume: Volume 49
• Publisher: CHURCHILL LIVINGSTONE | 2020-03-01, Pages 102348-102348
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.ctim.2020.102348
• Subjects: Health Sciences, Public Health; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Integrative & Complementary Medicine; Sickle cell disease; Chronic pain; Cognitive-behavioral therapy; Healthcare utilization; Patient-reported outcomes; EMERGENCY-DEPARTMENT RELIANCE; QUALITY-OF-LIFE; FUNCTIONAL DISABILITY; CHILD-PSYCHOTHERAPY; COMPREHENSIVE PAIN; MENTAL-HEALTH; FAMILY; COST; ADOLESCENTS; STRATEGIES

Abstract

Objectives: Evaluate the implementation of cognitive-behavioral therapy (CBT) for chronic pain in a clinical setting by comparing youth with sickle cell disease (SCD) who initiated or did not initiate CBT. Design: Youth with SCD (ages 6–18; n = 101) referred for CBT for chronic pain were compared based on therapy attendance: Established Care; Early Termination; or Comparison (i.e., did not initiate CBT). Setting: Outpatient pediatric psychology and comprehensive SCD clinics in 3 locations at a southeastern children's hospital. Interventions: CBT delivery was standardized. Treatment plans were tailored to meet individualized needs. Main Outcome Measures: Healthcare utilization included pain-related inpatient admissions, total inpatient days, and emergency department reliance (EDR) at 12-months pre-post CBT. Patient-reported outcomes (PROs) included typical pain intensity, functional disability, and coping efficacy pre-post treatment. Results: Adjusting for age, genotype, and hydroxyurea, early terminators of CBT had increased rates of admissions and hospital days over time relative to comparisons; those who established care had faster reduction in admissions and hospital days over time relative to comparisons. EDR decreased by 0.08 over time for Established Care and reduced by 0.01 for every 1 completed session. Patients who completed pre- and post-treatment PROs reported decreases in typical pain intensity, functional disability, and improved coping efficacy. Conclusions: Establishing CBT care may support reductions in admissions for pain, length of stay, and EDR for youth with chronic SCD pain, which may be partially supported by patient-reported improvements in functioning, coping, and lower pain intensity following CBT. Enhancing clinical implementation of multidisciplinary treatments may optimize the health of these youth.