Yoga Therapy for Chronic Pain in Sickle Cell Disease

Abstract

BACKGROUND: Patients with sickle cell disease suffer from both acute and chronic pain that severely affects their quality of life. Acute pain secondary to vaso-occlusive pain crises are a frequent cause of hospitalization and missed days from school and work. Many adult patients also suffer from chronic pain, which can lead to feelings of anxiety, hopelessness and depression. There is very little evidence-based data on how to manage pain in sickle cell disease. This lack of data is evident in the most recent American Society of Hematology Guidelines on Management of Pain in Sickle Cell Disease, which was published in June 2020. In the United States, acute and chronic pain is largely managed with opioids, but these medications have significant side effects including dependence and potential for opioid-induced hyperalgesia. There is an expert recommendation to avoid chronic opioid therapy if possible, but unfortunately this leaves clinicians with few treatment options, mostly extrapolated from evidence in other diseases such as fibromyalgia and osteoarthritis. Therefore, efforts to provide other strategies for pain management are warranted. Yoga is a physical, mental, and spiritual practice that aims to promote health and positive thinking. It has proven therapeutic benefits in chronic pain syndrome by altering perception of and attitude towards pain. Additionally, it can be beneficial in alleviating anxiety and depression, which are highly prevalent in the sickle cell population. OBJECTIVE: The purpose of this study is to implement a 6 month-long intervention with weekly group yoga therapy sessions conducted virtually via videoconferencing software, incorporating aspects of meditation and breathing exercises. METHODS: Twenty patients with sickle cell disease have been recruited for this study. There will be a total of 24 group yoga therapy sessions held weekly for 6 months. The 1 hour-long virtual sessions are taught by a certified yoga therapist, focusing on meditation and low impact movements synchronized with breathing exercises. Video recordings are made available for those who cannot attend the live virtual sessions. Weekly questionnaires are administered to participants. The variables measured in surveys include: the pain catastrophizing scale, levels of anxiety and depression, quality of sleep, use of opioids and other pain medications, number of hospitalizations and emergency room visits, and yoga session attendance. The primary outcome of this study is feasibility and acceptability of the yoga intervention. Secondary outcomes include changes in pain catastrophizing, depression and anxiety scores, frequency of emergency room and hospital admissions, and quantity of opioid medications utilized. RESULTS: The beginning of survey questionnaire results revealed that the participants had high amounts of ED visits, hospitalizations, pain, anxiety, and depression. The participants had a median of 3 (IQR 1.25-4) ER visits and 2 (IQR 0-2) hospitalizations in the past 6 months for SCD-related pain. The median score on the Pain Catastrophizing Scale was 40.5 (IQR 27.25-52.5), which was at the 93rd percentile of a standardized population. The median PHQ-9 score was 17 (IQR 13.25-22.5). Five (36%) participants had moderate depression, 3 (21%) moderately severe, and 6 (43%) severe. The median GAD-7 score was 18.5 (IQR 10.25-21.5). Three (21%) patients had mild anxiety, 2 (14%) moderate, and 9 (64%) severe. Live virtual attendance was 2 participants (11%) for the first session and 6 participants (32%) for the second session. Participation with viewing recorded sessions and weekly questionnaire data remain to be assessed, as the study is ongoing. CONCLUSION: As this study is among the first of its kind to examine therapeutic yoga for pain in adults with sickle cell disease, it has broad implications for chronic pain management in this field. Barriers that impact feasibility of the study, mostly centering on technological difficulties, were identified and strategies to address them are being developed and implemented in real-time as the study continues. The study population was found to have high levels of pain, anxiety, and depression in initial data collection, which further demonstrates the importance of the development of nonpharmaceutical strategies for improvement in pain and quality of life for these patients.