Although newborn screening and improvements in medical care have resulted in more favorable long-term prognosis for children and adults with sickle cell disease (SCD), 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 coping strategies used to deal with pain explain significant amounts of the variance in health care use, school/work and social activity, and depression and anxiety. The purpose of the proposed studies is to evaluate the effects of coping skills training on pain perception in children, adolescents, and adults with SCD. Based upon our earlier studies, we hypothesize that rehearsal of relaxation, distraction, and other cognitive coping strategies will raise pain threshold and tolerance over baseline levels. We also suspect that an improved ability to tolerate pain will be associated with actual clinical benefits. Two studies are proposed: Study 1 with 80 adults, and Study 2 with 80 children and adolescents. In both studies, patients will undergo a baseline assessment of pain threshold and tolerance using experimental pain induction techniques under controlled laboratory conditions. Subjects (and the parents in Study 2) will also complete psychological questionnaires, self-monitoring records, and interview data verified with medical records to assess coping strategies, negative thoughts, pain frequency, health care use, social and work activity, and depression and anxiety. Subjects will then be randomly assigned to one of two conditions: Cognitive Coping Rehearsal or a control condition. Posttesting will involve a repeat assessment of pain threshold and tolerance and the measures of adjustment. 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. Multivariate analyses will be used to compare the coping rehearsal to the control condition on measures of pain perception and adjustment. 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 may also help us 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 SCD.
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