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Meta-Analysis
. 2015 May 8;2015(5):CD001916.
doi: 10.1002/14651858.CD001916.pub3.

Psychological therapies for sickle cell disease and pain

Kofi A Anie  1 , John Green
Affiliations
Meta-Analysis

Psychological therapies for sickle cell disease and pain

Kofi A Anie et al. Cochrane Database Syst Rev. .

Abstract

Background: Sickle cell disease comprises a group of genetic blood disorders. It occurs when the sickle haemoglobin gene is inherited from both parents. The effects of the condition are: varying degrees of anaemia which, if severe, can reduce mobility; a tendency for small blood capillaries to become blocked causing pain in muscle and bone commonly known as 'crises'; damage to major organs such as the spleen, liver, kidneys, and lungs; and increased vulnerability to severe infections. There are both medical and non-medical complications, and treatment is usually symptomatic and palliative in nature. Psychological interventions for individuals with sickle cell disease might complement current medical treatment, and studies of their efficacy have yielded encouraging results. This is an update of a previously published Cochrane Review.

Objectives: To examine the evidence that psychological interventions improve the ability of people with sickle cell disease to cope with their condition.

Search methods: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and the Internet, handsearches of relevant journals and abstract books of conference proceedings.Date of the most recent search of the Group's Haemoglobinopathies Trials Register: 17 February 2015.

Selection criteria: All randomised or quasi-randomised controlled trials comparing psychological interventions with no (psychological) intervention in people with sickle cell disease.

Data collection and analysis: Both authors independently extracted data and assessed the risk of bias of the included studies.

Main results: Twelve studies were identified in the searches and seven of these were eligible for inclusion in the review. Five studies, involving 260 participants, provided data for analysis. One study showed that cognitive behaviour therapy significantly reduced the affective component of pain (feelings about pain), mean difference -0.99 (95% confidence interval -1.62 to -0.36), but not the sensory component (pain intensity), mean difference 0.00 (95% confidence interval -9.39 to 9.39). One study of family psycho-education was not associated with a reduction in depression. Another study evaluating cognitive behavioural therapy had inconclusive results for the assessment of coping strategies, and showed no difference between groups assessed on health service utilisation. In addition, family home-based cognitive behavioural therapy did not show any difference compared to disease education. One study of patient education on health beliefs showed a significant improvement in attitudes towards health workers, mean difference -4.39 (95% CI -6.45 to -2.33) and medication, mean difference -1.74 (95% CI -2.98 to -0.50). Nonetheless, these results may not apply across all ages, severity of sickle cell disease, types of pain (acute or chronic), or setting.

Authors' conclusions: Evidence for the efficacy of psychological therapies in sickle cell disease is currently limited. This systematic review has clearly identified the need for well-designed, adequately-powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions in sickle cell disease.

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Conflict of interest statement

Kofi Anie: none known.

John Green: none known.

Figures

1.1
1.1. Analysis
Comparison 1 Patient education compared with usual treatment, no intervention or control, Outcome 1 Mood ‐ depression.
1.2
1.2. Analysis
Comparison 1 Patient education compared with usual treatment, no intervention or control, Outcome 2 Health beliefs ‐attitudes (medical services) ‐ no time point.
1.3
1.3. Analysis
Comparison 1 Patient education compared with usual treatment, no intervention or control, Outcome 3 Health beliefs ‐ attitudes (medication use) ‐ no time point.
2.1
2.1. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 1 Pain frequency (% pain days).
2.2
2.2. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 2 Pain severity (emotion).
2.3
2.3. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 3 Pain severity (sensation).
2.4
2.4. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 4 Coping strategies.
2.5
2.5. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 5 Health service utilisation (emergency visits).
2.6
2.6. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 6 Health service utilisation (hospital admissions).
2.7
2.7. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 7 Health service utilisation (outpatient clinic visits).
2.8
2.8. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 8 Quality of life ‐ daily function.
2.9
2.9. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 9 Health beliefs ‐ locus of control (chance).
2.10
2.10. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 10 Health beliefs ‐ locus of control (powerful others).
2.11
2.11. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 11 Health beliefs ‐ locus of control (internal).
2.12
2.12. Analysis
Comparison 2 Cognitive behavioural therapy (CBT) compared with usual treatment, no intervention or control, Outcome 12 Mental health.
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Update of

References

References to studies included in this review

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References to studies excluded from this review

Applegate 2003 {published data only}
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    1. Boyd RC, Barakat LP, Thigpen NR, Radcliffe J. The development of a brief psychoeducational intervention for adolescents with sickle cell [abstract]. 27th Annual Meeting of the National Sickle Cell Disease Program; 2004 April 18‐21; Los Angeles, California. 2004:84.
Ketchen 2006 {published data only}
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References to other published versions of this review

Anie 2000
    1. Anie KA, Green J. Psychological therapies for sickle cell disease and pain (Cochrane review). Cochrane Database of Systematic Reviews 2000, Issue 3. [DOI: 10.1002/14651858.CD001916] - DOI - PubMed
Anie 2012
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