Home-Based Self-Management of Chronic Pain in Adults with Sickle Cell Disease: Applying a Biopsychosocial and Technological Approach

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PROJECT SUMMARY/ABSTRACT. In adults with sickle cell disease (SCD), chronic pain is associated with substantial morbidity, mortality, and healthcare utilization. The incidence of chronic pain in SCD is high and is likely to increase as affected individuals transition through young adulthood. However, Black adults with SCD often encounter challenges in obtaining comprehensive care for chronic pain that includes behavioral pain management strategies. As a result, chronic pain is typically managed with opioids but opioids alone are often suboptimal, are associated with poor health outcomes, and their use is limited by access restrictions due to the current opioid epidemic in the United States. Therefore, alternative, evidence-based, non-pharmacological options are needed to address the psychosocial aspects of chronic pain and support pain self-management in the home setting in order to decrease the burden of SCD and improve the quality of life of affected individuals. Virtual reality (VR) is a timely and innovative tool that has resulted in pain reduction for individuals who experience chronic pain conditions, such as complex regional pain syndrome, fibromyalgia, and chronic migraines. While VR applications have typically been used in a clinic or hospital setting primarily for acute pain, cost reductions and advances in the technology have created the potential for its long-term use at home. In addition, the popularity of mobile and gaming technology among young adults suggests that VR is a promising delivery platform. Therefore, VR may be utilized to implement home-based chronic pain self-management for adults with SCD. To date, there have been no published studies of VR interventions for chronic pain management in the home setting for adults with SCD. This project will evaluate AppliedVR's EaseVRx – a multi-modal, skills-based, 8-week, VR, home intervention – in an exploratory trial for self-management of chronic pain among 60 Black, young adults (ages 18–40) with SCD. EaseVRx experiences are based on evidence-based pain management approaches related to pain education, pain psychology, biofeedback training, relaxation, and distraction. Similar to in-person integrative pain management programs, EaseVRx provides therapeutic information to support participants in learning cognitive and behavior self-management skills, and retraining the pain pathways. A single-site, mixed-methods, exploratory, parallel-group randomized controlled trial (RCT), of EaseVRx versus active control, among adults with SCD will be conducted to: 1) determine the feasibility of using EaseVRx for self-management of chronic pain; 2) assess the preliminary efficacy of EaseVRx on pain and pain-related outcomes; and 3) assess how EaseVRx can be tailored for a target audience that mostly consists of Black individuals. Data will be obtained from electronic medical records, validated surveys, a pain dairy, device usage statistics, and qualitative individual interviews or focus group sessions. This project aligns with the priorities of NINR. Study findings will be used to develop and test a tailored, home-based, pain self-management intervention for adults with SCD in a larger RCT.