Sickle cell disease (SCD) is a major health problem, affecting approximately 1 in 400 African American newborns. 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. Although some patients cope well with pain, others suffer significant vocational and psychosocial dysfunction and become overly dependent upon health care services. Over the past three years, we have found that experimental pain methods are useful in analyzing clinical phenomenon in SCD pain. Our research has recently found that adults with SCD who report frequent negative thoughts are likely to report higher pain even when stimulus intensity is controlled and even to relative low levels of sensory stimulation. Adults who report few negative thoughts may be more stoic and not as apt to report pain. Furthermore, results from our intervention study indicate that brief training in cognitive coping rehearsal techniques may alter pain perception in adults with SCD and lead to short-term reductions in SCD ,pain severity and health care use. Follow-up data, however indicate that most patients do not maintain the improvements after the intervention is completed. Thus, the next step in our research program is to evaluate methods for enhancing the effects of our intervention and promoting its long-term benefit for patients. The purpose of this proposal is to evaluate the effect of a more comprehensive cognitive-behavioral training (CBT) protocol that incorporates training in behavioral as well as cognitive coping skills, a patient model to demonstrate cognitive- behavioral skills and systematic training in maintenance enhancement methods. In this study, 90 adults with SCD will be randomly assigned to either a cognitive coping rehearsal condition similar to our previous intervention, the comprehensive CBT protocol, or a patient-support control condition. Post-treatment evaluation will examine changes in experimental pain sensitivity, clinical SCD pain, health care use, work and social activity and depression and anxiety. To evaluate longer-term maintenance of improvements, 6-month and 1-year follow-up data will be collected. Multivariate analyses will be used to compare the three conditions. We expect that the patients in the comprehensive CBT protocol will have the greatest improvements in pain sensitivity and clinical status. Ultimately, we expect that this research will help us determine whether we can intervene and promote long-term, clinically significant reductions in health care use and improvements in the quality of life for patients with SCD.
