Mindfulness Practices for Chronic Pain in Sickle Cell Disease

Background: Patients with sickle cell disease (SCD) suffer from both acute and chronic pain that severely affects their quality of life. Pain is largely managed with opioids, which have significant side effects including dependence, adverse mood effects, and potential for opioid-induced hyperalgesia. The 2020 American Society of Hematology guidelines for SCD suggests cognitive and behavioral pain management strategies (including mind-body interventions). However, there remains low certainty in the evidence of these modalities. We chose to pursue mindfulness-based interventions given their proven efficacy in other chronic pain syndromes and associated mental health disorders.

Objective: The purpose of our pilot study was to assess the feasibility and acceptability of weekly group yoga therapy sessions conducted virtually via videoconferencing software in patients with sickle cell disease and chronic pain, defined as pain on more than 15 days per month for the last 6 months.

Design: Twenty patients with SCD were recruited for weekly virtual group yoga therapy sessions, which incorporated aspects of mindfulness meditation and low impact movements synchronized with breathing exercises (see Table 1).

Results: Twenty out of 22 patients (92%) approached for the study agreed to participate. The median age of participants was 35 (IQR 26-43), with the majority being female (n=13 out of 19, 68%). The baseline survey revealed participants had frequent Emergency Department visits (median 3, IQR 1.25-4) and hospitalizations (median 2, IQR 0-2) in the 6 months prior to the intervention. The study population exhibited high levels of pain catastrophizing (median PCS 40.5, IQR 27.25-52.5, 93%tile), anxiety (median GAD-7 18.5, IQR 10.25-21.5), and depression (median PHQ-9 17, IQR 13.25-22.5). On average, 15% of participants (range 2-32%) attended each session. Barriers to participation included technologic difficulties, time conflicts, and inability to contact participants. The participants who consistently attended the sessions had positive feedback. One participant stated, "It went well for me. Meditation was helpful...[and] the yoga helped with my knee." Another participant commented, "I liked having a community with the other patients."

Conclusions and Future Directions: This pilot study was among the first of its kind to examine mindfulness practices for chronic pain in adults with SCD. While there was a high rate of agreement to participate in the study, indicating a willingness and receptiveness to the study intervention, the overall participation per session was low. The study population had high rates of health care utilization despite most participants being on chronic opioid therapy and disease modifying medications, which illustrates the need for additional therapeutic strategies. A striking aspect of the baseline survey was the high rates of pain catastrophizing, anxiety, and depression, which directly impact chronic pain and thus require a holistic approach that includes mindfulness-based interventions. Our future research will draw upon lessons learned from the pilot study to address barriers to participation.

No relevant conflicts of interest to declare.