Psychological therapies for sickle cell disease and pain (Cochrane Review)

A substantive amendment to this systematic review was last made on 18 January 2002. Cochrane reviews are regularly checked and updated if necessary.

Background: Sickle cell disease comprises a group of genetic blood disorders. It occurs when the sickle haemoglobin gene is inherited from both parents. The effects of the condition are: varying degrees of anaemia which, if severe, can reduce mobility; a tendency for small blood capillaries to become blocked causing pain in muscle and bone commonly known as "crises"; damage to major organs such as the spleen, liver, kidneys, and lungs; and increased vulnerability to severe infections. There are both medical and non-medical complications, and treatment is usually symptomatic and palliative in nature. Psychological interventions for individuals with sickle cell disease might complement current medical treatment, and studies of their efficacy have yielded encouraging results.

Objectives: To examine the evidence that psychological interventions improve the ability of people with sickle cell disease to cope with their condition.

Search strategy: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register, which comprises references identified from comprehensive electronic database searches and the internet, handsearching of relevant journals and abstract books of conference proceedings. Date of the most recent search of the Group's trials register: October 2002.

Selection criteria: All randomised or quasi-randomised controlled trials comparing psychological interventions with no (psychological) intervention in people with sickle cell disease.

Data collection and analysis: Both reviewers independently extracted data and assessed trial quality.

Main results: Six studies were identified in the searches, of which four, involving 223 participants, were eligible for inclusion in the review. One study showed that cognitive behaviour therapy significantly reduced the affective component of pain, weighted mean difference -3.00 (95% confidence interval (CI) -4.63 to -1.37), but not the sensory component, WMD 0.00 (95%CI -9.39 to 9.39). One trial of family psycho-education was not associated with a reduction in depression. Another study evaluating cognitive behavioural therapy had inconclusive results for the assessment of coping strategies, and showed no difference between groups assessed on health service utilisation.

Reviewers' conclusions: Evidence for the efficacy of psychological therapies in sickle cell disease is currently limited. This systematic review has clearly identified the need for well-designed, adequately powered, multicentre randomised controlled trials assessing the effectiveness of specific interventions in sickle cell disease.

Citation: Anie KA, Green J. Psychological therapies for sickle cell disease and pain (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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