Emory University School of Medicine, Department of Pediatrics, United States; Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States.
Children's Healthcare of Atlanta, Aflac Cancer and Blood Disorders Center, United States.
Complement Ther Med. 2020 Mar;49:102348. doi: 10.1016/j.ctim.2020.102348. Epub 2020 Feb 15.
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.
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).
Outpatient pediatric psychology and comprehensive SCD clinics in 3 locations at a southeastern children's hospital.
CBT delivery was standardized. Treatment plans were tailored to meet individualized needs.
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.
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.
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.
通过比较开始或未开始认知行为疗法（CBT）治疗慢性疼痛的镰状细胞病（SCD）青少年，评估临床环境中 CBT 治疗慢性疼痛的实施情况。
根据 CBT 治疗慢性疼痛的出勤率，将 SCD 青少年（6-18 岁；n=101）分为以下三组：建立治疗关系；早期终止治疗；或未建立治疗关系（即未开始 CBT）。
东南儿童医院的 3 个位置的儿科心理门诊和综合 SCD 诊所。
CBT 治疗方法标准化，治疗计划根据个人需求进行定制。
12 个月前后 CBT 治疗的医疗保健利用率包括与疼痛相关的住院人数、住院总天数和急诊部就诊依赖度（EDR）。患者报告的结果（PRO）包括治疗前后的典型疼痛强度、功能障碍和应对效能。
在调整年龄、基因型和羟基脲后，与对照组相比，早期终止 CBT 的患者住院率和住院天数随时间增加；与对照组相比，建立治疗关系的患者住院率和住院天数随时间减少。EDR 随时间推移，建立治疗关系的患者减少 0.08，每完成 1 次治疗减少 0.01。完成治疗前后 PRO 的患者报告典型疼痛强度、功能障碍减轻，应对效能提高。
为慢性 SCD 疼痛患者建立 CBT 治疗关系可能有助于减少疼痛相关住院、住院时间和 EDR，这可能部分归因于患者报告的功能、应对和疼痛强度改善。增强多学科治疗的临床实施可能会优化这些患者的健康状况。
