Pain is a defining feature of sickle cell disease, and the most frequently reported symptom. A lifetime of unpredictable, recurrent, intense, and frequently persistent pain experiences, and the accompanying recurring and necessary use of analgesic medications, make pain related to sickle cell disease unique among pain syndromes. In addition to episodes of acute pain, patients often experience chronic pain that is relatively constant. Medical management of severe, acute pain episodes includes hydration and analgesia, with the most severely painful episodes often managed on an inpatient basis. Chronic, inter-episodic pain is treated on an outpatient basis with analgesic medications and is often incompletely controlled. Patients and physicians alike express concern over patients' long-term reliance on analgesic medications. Despite these concerns, non-pharmacologial adjunctive management of sickle cell disease pain has received relatively little scientific attention. ? ? The proposed research will be the first to test the effects of in-home massage therapy administered by a trained family member and in-home relaxation training as complementary modalities for sickle cell disease pain. The study will determine the acceptability of both interventions to patients and families, and the relationship between each intervention and changes in pain, function, negative affect, and health care utilization in a sample of African American adolescents and adults with sickle cell disease. The interventions will be adjunctive measures and will not replace patients' standard medical care. Specifically, the present application proposes a randomized clinical trial comparing the effects of in-home, family administered massage therapy and in-home relaxation training on measures of physical status (pain, pain-related interference with functioning), affective function (depression, anxiety), and health care utilization (emergency department visits, hospitalizations, contacts with physicians, medication use). ? ? ?
