Sickle Cell Disease (SCD) is a major health problem, affecting approximately 1 in 400 African American births. Although newborn screening and improvements in medical care have resulted in more favorable long-term prognosis, most patients still encounter frequent unpredictable episodes of pain over their lifespan. Some SCD patients cope well with pain, however, many others suffer significant vocational and psychosocial dysfunction and become overly dependent upon health care services. Our research has recently found that the coping strategies used by adults with SCD to deal with pain explain significant amounts of the variance in health care use, work and social activity, and psychological distress. The intervening variables responsible for this relationship between coping strategies and adjustment to SCD are not well understood, however. The purpose of the proposed studies is to examine pain threshold and tolerance in SCD patients using experimental pain induction techniques under controlled conditions. In Study 1, 120 adults with SCD will complete a pressure simulation task using the Forgione-Barber pressure stimulator to determine pain threshold and tolerance. Subjects will also complete structured interviews and questionnaires to assess coping strategies, negative thoughts, and health care use, social and work activity, and depression and anxiety. Regression analyses will be used to determine: 1) the extent to which cognitive coping is related to pain threshold and tolerance levels, 2) and the degree to which variation in pain threshold and tolerance predicts adjustment over and above the variance accounted for by demographic and disease severity measures. Study 2 will randomly assign at-risk patients from Study 1 to either rehearsal of coping strategies or a delayed intervention/control condition, in order to investigate in a laboratory setting whether rehearsal of cognitive coping strategies raises pain threshold and tolerance over baseline levels. Short-term clinical benefit of the intervention will also be assessed using psychological questionnaires, self-monitoring records, and interview data verified with medical records. Multivariate analyses will be used to compare the two conditions. We expect that the findings of these studies will advance our long-term goals of developing more effective means to assess and treat pain in individuals with SCD. Examining pain through standardized experimental pain-induction techniques may help clarify the relationship between cognitive coping and adjustment in SCD. The findings of Study 2 may help use refine pain management approaches for use with SCD pain and demonstrate the utility of cognitive-behavioral interventions in modifying clinical pain perception and improving adjustment in individuals with SCD.
