Efficacy of non-pharmacological interventions to reduce pain in children
with sickle cell disease: a systematic review
Abstract
Background: Pain is the clinical hallmark of sickle cell
disease (SCD) leading to hospitalization, psychological sequelae and a
decreased health-related quality of life. The aim of this systematic
literature review is to evaluate the efficacy of non-pharmacological
interventions in reducing sickle cell-related pain in children with SCD.
Methods: A comprehensive literature search up until October
2022 was performed to identify studies that investigated the efficacy of
non-pharmacological interventions on (1) pain frequency and/or
intensity, and (2) analgesic and health service use in children with
SCD. Randomized controlled (RCTs) trials and quasi-experimental designed
(QED) studies that investigated non-pharmacological interventions for
pediatric patients with SCD until the age of 21 years were considered
for inclusion. Results: Ten articles (5 RCTs and 5 QED studies)
with 422 participants were included. They investigated cognitive
behavioral therapy (CBT) (n =5), biofeedback (n=2), massage (n=1),
virtual reality (n=1) and yoga (n=1). CBT, biofeedback, massage, virtual
reality and yoga significantly reduced frequency and/or intensity of
SCD-related pain. Biofeedback also significantly reduced analgesic use.
Conclusion: Non-pharmacological interventions may be effective
in reducing pain in pediatric SCD patients. However, due to the
heterogeneity of the included studies a quantitative analysis could not
be performed. Awaiting further supporting evidence, healthcare providers
should consider implementing these interventions as valuable part of a
comprehensive pain management strategy plan to improve the outcome of
sickle cell-related pain.