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Author Notes:

Soumitri Sil, Ph.D., Emory University School of Medicine, Children’s Healthcare of Atlanta, 2015 Uppergate Drive, 426H, Atlanta, GA 30322, Phone: (404) 727-2712, Fax: (404) 727-4455, Email: soumitri.sil@emory.edu

SS, KL, JL, JGM, BT, and LLC have no conflicts of interest to report. PL has research funding from NIH/NHLBI and Centers for Disease Control; he is on the advisory board of Bio Products Laboratory and FORMA Therapeutics; and he is on a contract for newborn screening services with the Georgia Department. CD has research funding from Pfizer, Micelle BioPharma, Novartis, Merck, Katz Foundation, and NIH/NICHD/NCATS; he is a consultant for Pfizer, Novartis, Global Blood Therapeutics, Epizyme, Micelle BioPharma, Modus Therapeutics, Hilton Publishing Company, and Ironwood Pharmaceutics; and he is on the advisory board of Pfizer, Novartis, and Micelle BioPharma.

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Research Funding:

This work was supported by Children’s Healthcare of Atlanta Clinical Innovation Grant and Abraham J & Phyllis Katz Foundation. Preparation of this paper was supported by the National Heart, Lung, and Blood Institute (NHLBI) [grant number 1K23Hl133457-01A1] to Soumitri Sil, PhD. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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

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

Tools:

Journal Title:

COMPLEMENTARY THERAPIES IN MEDICINE

Volume:

Volume 49

Publisher:

, Pages 102348-102348

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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