I-STRONG: An integrative, multicomponent treatment approach for chronic pain in pediatric sickle cell disease
Blood Adv. 2026 Apr 23:bloodadvances.2025018952. doi: 10.1182/bloodadvances.2025018952. Online ahead of print.
ABSTRACT
Chronic pain affects about 20% of adolescents living with sickle cell disease (SCD). There is a critical unmet need for evidence-based interdisciplinary approaches for chronic SCD pain treatment. We aimed to: 1) utilize community engagement to adapt an integrative multicomponent treatment program designed to meet the unique needs of chronic SCD pain (i.e., I-STRONG for SCD), and 2) optimize feasibility and acceptability of I-STRONG through a proof-of-concept trial. Modifications to an existing cognitive-behavioral therapy (CBT) and neuromuscular treatment program for chronic widespread pain were informed by semi-structured qualitative interviews with adolescents (12-18 years old) with chronic SCD pain (n = 12) and their caregivers (n = 12), community advisory boards, and interdisciplinary experts to develop I-STRONG. I-STRONG is a virtual 8-week, 16-session, group intervention combining CBT and neuromuscular exercise training, co-led by experts in psychology and physical therapy. A pilot clinical trial of I-STRONG (n = 12 adolescents; n = 9 caregivers) was conducted to iteratively optimize intervention feasibility and acceptability. Community engagement strategies informed systematic adaptations for access, engagement, relevance, satisfaction, and sense of belonging to meet the unique needs of youth experiencing chronic SCD pain. Pilot testing demonstrated high levels of feasibility (95% completion, 97% intervention fidelity, 92% retention), moderate to high acceptability, and safety. Over 82% of adolescents reported improvements in pain at post-treatment and 3-month follow-up. Preliminary evidence suggests that I-STRONG is a promising approach for management of chronic pain in pediatric SCD. A planned multi-center, randomized controlled trial will evaluate I-STRONG's efficacy for pain reduction. NCT06110754.
PMID:42024471 | DOI:10.1182/bloodadvances.2025018952