source: The Journal of Pain

year: 2015

authors: M. Ezenwa, Y. Yao, R. Molokie, C. Engeland, Z. Wang, M. Suarez, Z. Zhao, J. Carrasco, R. Angulo, D. Wilkie

Pain of sickle cell disease (SCD) has both physiological and psychological components. Current treatment of SCD pain focuses on alleviating pain using opioids, but guided imagery is rarely used. This 2-phase, attention control pre-post randomized clinical trial was conducted to test the feasibility of a protocol focused on guided imagery (GI) for stress and pain reduction intervention in adults with SCD. Patients (N=21, mean age 30±8 years [ranged from 21-47 years], 95% African-American, 67% female) completed stress and pain measures daily for 2 weeks via an Android tablet and the experimental group watched any of six video clips (2-min, 5-min, 8-min, 10-min, 15-min, and 20-min lengths) regardless of whether they are stressed or not to obtain a minimal intervention dose, at stress onset and as often as they desired via the tablet.

We analyzed data using multi-level regression analysis. 100% of consented patients participated and 90% completed the study. Overall, patients used the tablet on 79% of study days; 100% reported that they liked the study; and 99% of questionnaire items were completed. At two weeks, there was a trend for effects of GI on stress and pain, wherein average stress intensity and composite pain index were lower for the GI group than the control group, but the difference was not statistically significant.

The study protocol was feasible and we were able to determine the effect size for the GI intervention and calculate the sample size needed to conduct an efficacy trial of GI intervention using this protocol in adults with SCD. Patients kept the scheduled study appointments and completed a simple and cost-effective trial of GI intervention on the mobile tablet device; the GI intervention shows promise for reducing the impact of stress on SCD pain and warrants a larger randomized clinical trial to determine its efficacy.

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