Connolly Megan E, Forman Sydney, Sharkey Christina M, Merwin Stephanie, Darbari Deepika S, Hardy Steven J
Departments of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Divisions of Hematology and Oncology, Children's National Hospital, Washington, District of Columbia, USA.
Pediatr Blood Cancer. 2023 Dec;70(12):e30667. doi: 10.1002/pbc.30667. Epub 2023 Sep 19.
Sickle cell disease (SCD) pain is associated with functional impairment, and treatment is often limited to pharmacological approaches with unwanted side effects. Although behavioral interventions exist for non-SCD pain populations, interventions designed to address pain-related impairment in SCD are lacking.
Twenty youth (9-17 years) with SCD completed a four-week telemedicine pain intervention (NCT04388241). Participants and caregivers completed baseline and post-intervention PROMIS pain measures and the Treatment Evaluation Inventory-Short Form (TEI-SF). Descriptive analyses assessed feasibility and acceptability. Reliable Change Index analyses assessed for significant post-intervention changes in pain functioning. Paired t test analyses compared baseline and post-intervention opioid prescription fills.
All participants completed at least one treatment session. Eighteen (90%) youth completed all sessions. Youth (100%) and caregivers (94%) rated the intervention as moderately or highly acceptable on the TEI-SF. Forty-seven percent of caregivers and 44% of youth reported reliably significant improvements in pain interference after the intervention (median T-score differences: 24.8 and 23.5, respectively). Sixty-five percent of caregivers (T-score improvement difference: 19.3) and 31% of youth (T-score improvement difference: 32) reported improvements in pain behaviors. There was no significant difference in opioid prescription fills pre- and post-intervention (P > 0.05).
The Balance Program is feasible, highly acceptable, and can be delivered remotely to reduce barriers to care. Approximately half of youth and caregivers reported significant declines in pain interference following the intervention, with substantial improvements in functioning for treatment responders. Behavioral pain interventions are important adjunctive treatments to uniquely address functional impairment associated with acute and chronic pain in SCD.
镰状细胞病（SCD）疼痛与功能障碍相关，治疗通常局限于有不良副作用的药物治疗方法。尽管存在针对非SCD疼痛人群的行为干预措施，但缺乏旨在解决SCD中与疼痛相关的功能障碍的干预措施。
20名9至17岁的SCD青少年完成了为期四周的远程医疗疼痛干预（NCT04388241）。参与者和照顾者完成了基线和干预后的患者报告结果测量信息系统（PROMIS）疼痛测量以及治疗评估量表简表（TEI-SF）。描述性分析评估了可行性和可接受性。可靠变化指数分析评估了干预后疼痛功能的显著变化。配对t检验分析比较了基线和干预后的阿片类药物处方配药情况。
所有参与者至少完成了一次治疗课程。18名（90%）青少年完成了所有课程。青少年（100%）和照顾者（94%）在TEI-SF上对干预的评价为中度或高度可接受。47%的照顾者和44%的青少年报告干预后疼痛干扰有可靠的显著改善（T评分中位数差异分别为24.8和23.5）。65%的照顾者（T评分改善差异：19.3）和31%的青少年（T评分改善差异：32）报告疼痛行为有改善。干预前后阿片类药物处方配药情况无显著差异（P>0.05）。
平衡计划是可行的、高度可接受的，并且可以远程提供以减少护理障碍。大约一半的青少年和照顾者报告干预后疼痛干扰显著下降，治疗有反应者的功能有实质性改善。行为疼痛干预是独特解决SCD中急性和慢性疼痛相关功能障碍的重要辅助治疗方法。
