Digital cognitive behavioral therapy vs. education intervention in population with sickle cell disease experiencing pain: A systematic review

Abstract

Abstract Introduction: Chronic pain in sickle cell disease (SCD) patients impairs daily functioning and quality of life, despite advances in pharmacological treatments. Digital cognitive behavioral therapy (dCBT) and educational interventions present promising nonpharmacologic strategies. This systematic review assesses the efficacy of these interventions, as well as their potential for digital delivery in SCD pain management. Methods: Following PRISMA guidelines, we screened randomized controlled trials (RCTs) from PubMed MEDLINE, CNKI, Scopus, Web of Science, Cochrane, EMBASE, and CINAHL (01/20/2025). Our PROSPERO-registered protocol (CRD42025650053) guided selection. Results: From 142 studies, 81 were screened, 13 underwent full-text review, and two RCTs (n=470) met eligibility criteria. Studies from the US and Canada assessed dCBT versus education for SCD pain over six months in adults and adolescents, primarily Black/African American females. Neither intervention significantly reduced post-treatment pain, anxiety, or depression. However, cognitive behavioral therapy (dCBT) demonstrated superior mood improvements at six months and greater reductions in fatigue. Conclusion: These findings highlight critical factors influencing intervention effectiveness, including sample size, age, engagement, and intervention type. Future research should optimize dCBT implementation and engagement strategies to enhance outcomes. Understanding these elements is essential for developing effective digital interventions for SCD chronic pain management. Keywords: Sickle Cell Disease, Chronic Pain, Digital Cognitive Behavioral Therapy, Educational Interventions, Pain Management, Systematic Review, Randomized Controlled Trials, Adults, Adolescents.