Computerized Cognitive Behavioral Therapy Assisted Life Management for Pain in Sickle Cell Disease
Computerized Cognitive Behavioral Therapy Assisted Life Management for Pain in Sickle Cell Disease
The primary aim of this study is to test the feasibility and acceptability of implementing a
 multimedia computerized cognitive behavioral therapy (cCBT) program for reducing SCD pain
 symptoms in a single-arm pilot pragmatic clinical trial. The investigators will recruit 40
 SCD patients with chronic pain and/or on chronic opioid pain treatment and randomize them 3:1
 to two groups (cCBT and e-Education respectively), randomizing unevenly in order to best
 gather feasibility data for the cCBT. Both groups will use a mobile app to track daily
 pain/mood. The cCBT group will receive sessions of the CALM-SCD program to complete via
 mobile device and will have weekly follow-up with a care coach. The Education group will
 receive online education modules to complete via mobile device and will also have weekly
 follow-up with a care coach. The primary outcomes of the trial include feasibility
 (recruitment, retention, provider and patient feedback) and acceptability (sessions
 completed) of the CALM-SCD program.
The objective of this study is to provide the experiences and data that will support a later,
 larger, and adequately powered effectiveness trial of the CALM-SCD, computerized cognitive
 behavioral therapy (cCBT) program. The investigators hypothesize that CALM-SCD is acceptable,
 i.e., patients will use it (90% of users will complete the first lesson within 3 months; 70%
 will complete³4 sessions; 50% of users will complete all 8 sessions), and feasible, i.e., the
 investigators can recruit >80% of patients approached, and >90% of enrolled participants will
 complete their 6-month follow-up assessment. The investigators will also have preliminary
 data on effectiveness and hypothesize that 70% of cCBT users will achieve a >50% decline in
 daily pain ratings.

 The investigators will enroll 40 SCD patients at the University of Pittsburgh Medical Center
 (UPMC) with chronic pain to either CALM-SCD or pain education (eEducation) and follow them
 for 12 months. Implementation of routine stress/pain screening in the UPMC Adult Sickle Cell
 Clinic allows investigators to identify patients with SCD who have chronic pain as indicated
 by self-report "I have had pain nearly every day for at least 3 months" or have been
 prescribed long-acting opioids for pain.

 Following confirmation of protocol-eligibility and informed consent, investigators will
 provide all patients with a large-screen smartphone (unless the patient owns their own
 compatible large-screen smartphone) with a symptoms diary app, and GPS tracking features
 pre-installed; this will allow investigators to track pain and mood as well as any opioid or
 non-opioid pain treatments used by patients, and steps traveled.

 Patients enrolled in the CALM-SCD group will complete at least 4 1-hour cCBT sessions over 3
 months using their personal or study-provided smartphone. Because cCBT programs are less
 effective without a human support component, participants will also be introduced to a care
 coach (master's level student tech who will receive training in CBT) who will contact them on
 a weekly basis by phone/text for up to 3 months. The care coach will reinforce CBT materials
 and encourage engagement. Participants will have continued access to the program after first
 3 months, but care coach support will only be available on an as-needed basis.

 Patients enrolled in the eEducation group will receive pain education through online modules
 that they will be asked to complete using their study-provided smartphone. Each module
 includes learning tasks, a reading assignment, and a short quiz based on material. The
 education group will receive care coach contact on the same schedule as the cCBT group. The
 care coach will provide supportive therapy and encouragement to complete modules and apply
 the lessons to their daily life.

 Patients who are not eligible or who are not randomized into one of the intervention arms of
 this study will serve as a comparison group to ensure we are treating a representative sample
 of patients. Further, patients who were eligible but were not randomized into one of the
 intervention arms will serve as a usual care control group.
Inclusion Criteria:

 -  To be eligible for the study, patients must be 18 years of age or older, have a
 documented diagnosis of SCD (HgbSS, HgbSC, SB+Thal, or SBoThal), receive routine care
 at the UPMC Sickle Cell Clinic, and self-report chronic pain or have been prescribed
 long-acting opioids for pain.

 Exclusion Criteria:

 -  Unable to provide informed consent due to low literacy or cognitive difficulties