The overarching goal of this candidate's program of research is to improve behavioral and physical health and reduce health disparities by using multimedia technology to deliver evidence-based interventions to underserved populations. The focus is sickle cell disease (SCD), a condition that disproportionately affects those of African descent. Many people living with SCD suffer from daily chronic pain as well as recurrent acute pain episodes that require medical attention. Opioid medication is the primary treatment for pain in SCD, despite its limited effectiveness and negative side-effects. The proposed K23 attempts to address the need for an alternative, non-pharmacological pain treatment in SCD. Computerized cognitive behavioral therapy (cCBT) has been found effective for reducing chronic pain and may be a low cost, easily accessible and scalable pain treatment in SCD. The candidate's K12 project tested a cCBT program for anxiety and depression; preliminary results suggest that patients liked using the program, but found that much of its content did not relate to their lives. To address this limitation, the proposed K23 project will adapt an existing cCBT program for pain management to create ReThink Pain SCD, a culturally-tailored, mobile-phone delivered behavioral intervention designed specifically to help African American patients self-manage chronic sickle cell pain.
Aim 1 : Modify and tailor the generic cCBT pain program, using qualitative research methods to understand the needs and barriers to pain management in patients with SCD, as well as the opportunities to engage this population using multimedia. These data will inform the development of the features and content of ReThink Pain SCD.
Aim 2 : Conduct a pilot pragmatic clinical trial to test the feasibility and acceptability of implementing this pain intervention into routine SCD care. Forty patients with SCD will be randomized to either receive 8 sessions of the cCBT program or 8 online education modules on a smartphone. Primary outcomes of the trial include feasibility (recruitment, retention, provider and patient feedback) and acceptability (sessions completed) of the ReThink Pain SCD program. In order to achieve the goals of this research plan and transition to independence, the candidate requires further training in user-centered design, implementation science, design and conduct of pragmatic clinical trials, and team management and leadership. This proposal includes an exceptional team of mentors and consultants. Primary mentor Dr. Bruce Rollman is founding Director of the Center for Behavioral Health and Smart Technology. Co-mentor Dr. Robert Noll is a clinical psychologist with expertise in behavioral intervention trials. Co-mentor Dr. Laura De Castro is a nationally recognized trialist and expert in sickle cell disease. This training and research plan will form the basis for a future multicenter clinical trial testing the efficacy of ReThink Pain SCD for improving pain outcomes among adults with SCD, to be proposed in an R01 grant application before the end of the K23 award.

Public Health Relevance

This project seeks to determine whether a tailored behavioral intervention delivered over mobile phones can be an effective therapy for chronic pain in a predominately African American patient population, specifically patients living with sickle cell disease. Ultimately, this research will inform the delivery of evidence-based pain treatment in racial and ethnic minorities living with chronic pain.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (MPOR (OA))
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Werner, Ellen
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University of Pittsburgh
Internal Medicine/Medicine
Schools of Medicine
United States
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Jonassaint, Charles R; Birenboim, Amit; Jorgensen, Dana Rae et al. (2017) The association of smartphone-based activity space measures with cognitive functioning and pain sickle cell disease. Br J Haematol :