Non Pharmacological Pain Management in Sickle Cell Disease, a Narrative Review.
- 1Department of Nursing Sciences, Kampala International University, Western Campus, Kampala, Uganda.
- 2Department of Education Sciences, Kampala International University, Western Campus, Kampala, Uganda.
Abstract
Pain is a major cause of morbidity, disability, and reduced quality of life among people living with sickle cell disease (SCD). Although pharmacological treatment remains essential, non pharmacological interventions may provide complementary strategies for pain coping and symptom management. However, the strength of evidence supporting individual interventions varies considerably. This narrative review aimed to critically evaluate the evidence for non pharmacological interventions used to manage acute and chronic pain in SCD, distinguish disease-specific findings from indirect evidence, identify limitations in the literature, and discuss implications for clinical practice and resource-constrained settings. The review examined randomized controlled trials, quasi-experimental studies, observational studies, systematic reviews, and clinical practice guidelines addressing non pharmacological pain management in SCD. The evidence covered psychological and behavioral interventions, physical and sensory approaches, technology-assisted interventions, and supportive coping practices. Original SCD-specific studies were prioritized when evaluating intervention effectiveness. Findings from other chronic pain populations were treated as contextual evidence rather than proof of effectiveness in SCD. The evidence was most developed for selected psychological and behavioral interventions, particularly cognitive behavioral therapy (CBT) and biofeedback in pediatric populations. In a multicenter randomized controlled trial involving adolescents with SCD, a digital CBT intervention was associated with a greater reduction in average pain intensity and fewer pain days at six months than an education control. Pediatric systematic reviews also identified studies investigating massage, virtual reality, yoga, and biofeedback; however, the evidence was limited by intervention heterogeneity, small sample sizes, methodological limitations, and inconsistent outcome reporting. The American Society of Hematology conditionally recommended massage, yoga, transcutaneous electrical nerve stimulation (TENS), virtual reality, and guided audiovisual relaxation as adjuncts for acute SCD pain, based on very-low-certainty evidence. The available evidence for TENS was insufficient to establish benefit or harm. SCD-specific evidence for acupuncture, mindfulness-based interventions, hypnosis, and spiritual interventions was insufficient to establish their comparative analgesic effectiveness. Non pharmacological interventions may complement pharmacological treatment and support pain coping in SCD, but their effectiveness should be evaluated individually rather than assumed across intervention categories. Clinical decisions should consider patient preferences, intervention-specific evidence, clinical circumstances, safety, and local resources. Larger controlled trials and implementation studies, particularly in sub-Saharan Africa and other low- and middle-income countries, are needed.
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BibTeX
@article{daudi2026pharmacological,
title = {{Non Pharmacological Pain Management in Sickle Cell Disease, a Narrative Review.}},
author = {Kabuleta Daudi and Josfeena Bashir and Lucy Aja},
journal = {Journal of pain research},
year = {2026},
month = nov,
doi = {10.2147/jpr.s634972},
url = {https://europepmc.org/article/MED/42999871},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Non Pharmacological Pain Management in Sickle Cell Disease, a Narrative Review.
AU - Kabuleta Daudi
AU - Josfeena Bashir
AU - Lucy Aja
PY - 2026
DA - 2026/11/03
JO - Journal of pain research
DO - 10.2147/jpr.s634972
UR - https://europepmc.org/article/MED/42999871
AB - Pain is a major cause of morbidity, disability, and reduced quality of life among people living with sickle cell disease (SCD). Although pharmacological treatment remains essential, non pharmacological interventions may provide complementary strategies for pain coping and symptom management. However, the strength of evidence supporting individual interventions varies considerably. This narrative review aimed to critically evaluate the evidence for non pharmacological interventions used to manage acute and chronic pain in SCD, distinguish disease-specific findings from indirect evidence, identify limitations in the literature, and discuss implications for clinical practice and resource-constrained settings. The review examined randomized controlled trials, quasi-experimental studies, observational studies, systematic reviews, and clinical practice guidelines addressing non pharmacological pain management in SCD. The evidence covered psychological and behavioral interventions, physical and sensory approaches, technology-assisted interventions, and supportive coping practices. Original SCD-specific studies were prioritized when evaluating intervention effectiveness. Findings from other chronic pain populations were treated as contextual evidence rather than proof of effectiveness in SCD. The evidence was most developed for selected psychological and behavioral interventions, particularly cognitive behavioral therapy (CBT) and biofeedback in pediatric populations. In a multicenter randomized controlled trial involving adolescents with SCD, a digital CBT intervention was associated with a greater reduction in average pain intensity and fewer pain days at six months than an education control. Pediatric systematic reviews also identified studies investigating massage, virtual reality, yoga, and biofeedback; however, the evidence was limited by intervention heterogeneity, small sample sizes, methodological limitations, and inconsistent outcome reporting. The American Society of Hematology conditionally recommended massage, yoga, transcutaneous electrical nerve stimulation (TENS), virtual reality, and guided audiovisual relaxation as adjuncts for acute SCD pain, based on very-low-certainty evidence. The available evidence for TENS was insufficient to establish benefit or harm. SCD-specific evidence for acupuncture, mindfulness-based interventions, hypnosis, and spiritual interventions was insufficient to establish their comparative analgesic effectiveness. Non pharmacological interventions may complement pharmacological treatment and support pain coping in SCD, but their effectiveness should be evaluated individually rather than assumed across intervention categories. Clinical decisions should consider patient preferences, intervention-specific evidence, clinical circumstances, safety, and local resources. Larger controlled trials and implementation studies, particularly in sub-Saharan Africa and other low- and middle-income countries, are needed.
SN - 1178-7090
ER -