Jonassaint Charles R, Lalama Christina M, Carroll C Patrick, Badawy Sherif M, Hamm Megan E, Stinson Jennifer N, Lalloo Chitra, Saraf Santosh L, Gordeuk Victor R, Cronin Robert M, Shah Nirmish, Lanzkron Sophie M, Liles Darla, O'Brien Julia A, Trimnell Cassandra, Bailey Lakiea, Lawrence Raymona H, Saint Jean Leshana, DeBaun Michael, De Castro Laura M, Palermo Tonya M, Abebe Kaleab Z
Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins Sickle Cell Center for Adults, Johns Hopkins University School of Medicine, Baltimore, MD.
Blood Adv. 2024 Dec 24;8(24):6257-6266. doi: 10.1182/bloodadvances.2024013861.
Despite the burden of chronic pain in sickle cell disease (SCD), nonpharmacological approaches remain limited. This multisite, randomized trial compared digital cognitive behavioral therapy (CBT) with a digital pain/SCD education program ("Education") for managing pain and related symptoms. Participants were recruited virtually from seven SCD centers and community organizations in the United States. Adults (aged ≥18 years) with SCD-related chronic pain and/or daily opioid use were assigned to receive either CBT or Education for 12 weeks. Both groups used an app with interactive chatbot lessons and received personalized health coach support. The primary outcome was the change in pain interference at six months, with secondary outcomes including pain intensity, depression, anxiety, quality of life, and self-efficacy. Of 453 screened participants, 359 (79%) were randomized to CBT (n = 181) or Education (n = 178); 92% were Black African American, and 66.3% were female. At six months, 250 participants (70%) completed follow-up assessments, with 16 (4%) withdrawals. Engagement with the chatbot varied, with 76% connecting and 48% completing at least one lesson, but 80% of participants completed at least one health coach session. Both groups showed significant within-group improvements in pain interference (CBT: -2.13; Education: -2.66), but no significant difference was observed between them (mean difference, 0.54; P = .57). There were no between-group differences in pain intensity, depression, anxiety, or quality of life. High engagement with health coaching and variable engagement with digital components may explain the similar outcomes between interventions in this diverse, hard-to-reach population.
尽管镰状细胞病（SCD）存在慢性疼痛负担，但非药物治疗方法仍然有限。这项多中心随机试验比较了数字认知行为疗法（CBT）与数字疼痛/SCD教育项目（“教育”）在管理疼痛及相关症状方面的效果。参与者通过虚拟方式从美国七个SCD中心和社区组织招募。患有SCD相关慢性疼痛和/或每日使用阿片类药物的成年人（年龄≥18岁）被分配接受CBT或教育，为期12周。两组都使用了带有交互式聊天机器人课程的应用程序，并获得个性化的健康教练支持。主要结局是六个月时疼痛干扰的变化，次要结局包括疼痛强度、抑郁、焦虑、生活质量和自我效能感。在453名筛查参与者中，359名（79%）被随机分配到CBT组（n = 181）或教育组（n = 178）；92%为非裔美国人，66.3%为女性。六个月时，250名参与者（70%）完成了随访评估，16名（4%）退出。与聊天机器人的互动情况各不相同，76%的人进行了连接，48%的人完成了至少一节课，但80%的参与者完成了至少一次健康教练课程。两组在疼痛干扰方面均显示出显著的组内改善（CBT组：-2.13；教育组：-2.66），但两组之间未观察到显著差异（平均差异为0.54；P = 0.57）。在疼痛强度、抑郁、焦虑或生活质量方面，两组之间没有差异。对健康教练的高参与度和对数字组件的不同参与度可能解释了在这个多样化、难以接触的人群中干预措施之间的相似结果。
