By Suleiman Tajudeen
…continued from last week
CITIZENS COMPASS — Milder pain – paracetamol or aspirin
Moderate pain- Ibuprofen or Diclofenac
Severe pain– Dyhdrocodein or co-proxamol, morphine or pethidine. Ballad (1998) opined that people find it difficult to cope with sickle cell painful conditions posed a challenge to the clinician hence they experience distress, disability and reduced quality of life as a result of pain and complications associated with sickle cell disorder. On the other hand, Anie (2008) asserted that some people with sickle cell disorder were able to cope well with their painful experience hence they work; active socially and recreationally; and are well adjusted psychologically.
Cognitive behavioural therapy: This suggests that psychological distress is caused by distorted thoughts about stimuli giving rise to distressed emotions. The essence of CBT intervention is to challenge the negative thought that comes as a result of SCD condition (i.e. thought of dying, continuous pain, poor interpersonal relationship, societal attitude towards them etc.) and the main aim of the therapist is to change these negative thoughts by checking them against reality and against other assumptions. Generally, the goal of therapy is to ensure that most of those thoughts are replaced by positive thought which will help them to live a more productive and self fulfilled life despites their sickle cell condition. Evidence based studies have shown that it reduces pain in people living with sickle cell disorder (Thomas et al 1999,Anie 2002,2003) and improves mood and psychological coping ability (Anie et al 2002,2005).
Coping skills: it is a behavioural tool which may be used by individuals to offset or overcome adversity, disadvantage, or disability without correcting or eliminating the underlying condition. Sickle cell disorder psychological conditions range from painful crises, low self esteem, fear of not living long, unhappy with their condition as people living with sickle cell disorder and the problem of interpersonal relationship. Since all the experiences above can not be totally eliminated, patients need to condition themselves to the situation and cope with it effectively. (i.e. coping with pain is a behavioural manifestation that could be used to manage the pain or discomfort that comes with sickle cell painful crises).
Insight Oriented Therapies: These approaches to psychotherapy are based on the notion that psychological wellbeing depends on self understanding of one’s condition. The therapist using this model of treatment should ensure that patient gained better understanding about the nature of sickle cell condition so that they could live a self fulfilled life without the condition disturbing their aims and objective in life (i.e. gained better understanding of the nature of pain he/she experienced and the way forward).
Group Therapy: A form of therapy in which several clients/patients (usually 5 to 10) meet regularly with one or more therapists to resolve personal problems. clients or patients that have experienced various kinds of pain in the past might come together in a group meeting where each member is given the opportunity to express his or her feelings and get feedback from other members if the group (i.e. client might get to know that his or her isn’t the worst after all).
Biofeedback: It is a technique to measure bodily function e.g breathing, muscle tension and to alter these functions through relaxation exercise (i.e. client/patient might be asked to pay attention to the part of the body he was experiencing pain through relaxation). Cozzi et al (1987,Anie ,2002,2003) studies have shown that it reduces pain intensity and also reduction in analgesia use at six months of treatment.
Self Hypnosis: This is a self induced state of mind due to extreme concentration of attention to experience thoughts, feelings and images as almost real. Dinged et al (1997,Anie et al 2003) clinical trial indicates that it reduced five pain days and reduction in analgesia use.
Psycho-Drama: It is a form of group therapy in which people act out their own emotional problems and conflicts in front of audiences in order to gain objectivity and understanding of them (i.e. client might be asked to act out their painful experiences in order to get better understanding of sickle cell painful experiences).
Progressive Relaxation Exercise: It involves tensing and relaxing each muscle group of the body,.from your toes to the facial muscle of your head. The purpose is to make patient to be aware of what it feels like when your muscles are relaxed (i.e. Therapists might engage patients experiencing one form of pain or the other in progressive relaxation).
Attention Diversion is another model of psychological treatment where you ask your patient to think about things that would take off their minds from the pain i.e. if a patient is in severe pain he or she might be encourage to more attention to the music or television in the room, in these sense he or she has distracted self attention from the pain and experience lesser pain.
Coping Strategies for Sickle Cell Disorder
In addition to psychological treatment approaches, there are several coping strategies that individuals with SCD can use to manage their pain and improve their quality of life. Some effective coping strategies include:
– Keeping a pain diary to track pain episodes and identify triggers
– Engaging in regular exercise, such as yoga or swimming, to reduce stress and improve mood
– Practicing relaxation techniques, such as deep breathing or meditation, to reduce stress and anxiety
– Connecting with others, such as friends, family, or a support group, to reduce feelings of isolation and stigma
Sickle cell disorder is a chronic condition that requires comprehensive management, including psychological treatment approaches. By incorporating psychoeducation, CBT, relaxation techniques, support groups, and mindfulness-based interventions into their treatment plan, individuals with SCD can better manage their pain, improve their mental health, and enhance their overall quality of life. It is important to note that some of the symptoms experienced by people living with sickle cell disorder could include anxiety, depression, poor interpersonal relationship, poor school attendance etc because of the frequent painful crises and other psychological symptoms hence the need for psychological intervention as adjuncts to other medical treatment.
REFERENCES
Anie, K. A., & Green, J. (2002). Psychological therapies for sickle cell disease and pain. Cochrane Database of Systematic Reviews, 2002(3), CD001916.
Anie, K. A., & Steptoe, A. (2003). Pain, mood, and opioid medication use in sickle cell disease. Hematology Journal, 14(1), 71-73.
Anie, K. A. (2005). Psychological complications in sickle cell disease. British Journal of Haematology, 129(6), 723-729.
Anie, K. A. (2008). Psychological approaches to sickle cell pain management and complementary methods. Unpublished training manual.
Kato, G. J. (2017). Sickle cell disease: A review. American Journal of Hematology, 92(10), 957-966.
National Heart, Lung, and Blood Institute. (2020). Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2020.
Rees, D. C., & Gibson, J. S. (2017). Sickle cell disease: A review of the evidence. British Journal of Haematology, 179(3), 349-363.
Dr Suleiman Tajudeen is a Director, Clinical Psychology at Lagos University Teaching Hospital (LUTH).
