I-STRONG: an integrative, multicomponent treatment approach for chronic pain in pediatric sickle cell disease

Clinical Snapshot

Key Findings

• P Value: Not reported; no inferential statistics presented for pilot outcomes

• Effect Size: Not reported; descriptive proportions only (>82% of adolescents reported pain improvement post-treatment and at 3-month follow-up)

• Primary Outcome: Feasibility and acceptability of I-STRONG in adolescents with chronic SCD pain: 95% session completion rate, 97% intervention fidelity, 92% participant retention, and moderate-to-high acceptability ratings

• Nnt Or Sensitivity: Not calculable from available data; no control group or comparative arm. Pain improvement reported as a proportion (>82%) without specification of validated threshold or MCID.

• Confidence Interval: Not reported

Clinical Application

The virtual 8-week group format is operationally feasible in settings with telehealth infrastructure. Co-facilitation by psychology and physical therapy requires interdisciplinary staffing, which may be a resource constraint in smaller or regional centres. The 16-session commitment over 8 weeks requires careful scheduling around school, hospitalisations, and acute illness episodes. SCD is a rare but growing condition in Australia, predominantly affecting communities of African, Middle Eastern, and South Asian heritage. The TGA has approved hydroxyurea for SCD, and voxelotor and crizanlizumab have limited availability. There is no specific PBS-listed psychological or physiotherapy program for chronic SCD pain. Medicare-subsidised telehealth (post-COVID expansion) and the NDIS may support access to components of this intervention. RACGP guidelines on chronic pain management emphasise multimodal, non-pharmacological approaches, consistent with I-STRONG's framework. Australian implementation would require culturally adapted community engagement processes, particularly for Aboriginal and Torres Strait Islander communities where SCD may co-exist with other haemoglobinopathies. The planned multicenter RCT results will be critical before any recommendation for Australian clinical adoption. Adolescents aged 12–18 years with a confirmed diagnosis of sickle cell disease and established chronic pain (distinct from acute vaso-occlusive crises), who have access to telehealth technology and are able to participate in group-based virtual sessions

Abstract

Chronic pain affects ∼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) use community engagement to adapt an integrative multicomponent treatment program designed to meet the unique needs of chronic SCD pain (ie, Integrative Strong Body and Mind Training [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 semistructured qualitative interviews with adolescents (aged 12-18 years) 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 after treatment and at 3-month follow-up. Preliminary evidence suggests that I-STRONG is a promising approach for management of chronic pain in pediatric SCD. A planned multicenter, randomized controlled trial will evaluate I-STRONG's efficacy for pain reduction. This trial was registered at www.clinicaltrials.gov as #NCT06110754.

References

1. 1.Sil, S., Mooney, J. T., Adkins, T. R., Sinha, C., Nuñez, M. A., Busbee, A., Dampier, C., Bai, S., Crosby, L. E., Thomas, S., Beasley, K., Lang, A. C., Murphy, B., Williams, J., Batts, K., Kurzhals, A., Quinn, C. T., Myer, G. D., Bakshi, N., Kesar, T., & Kashikar-Zuck, S. (2026). I-STRONG: an integrative, multicomponent treatment approach for chronic pain in pediatric sickle cell disease. Blood Advances. https://doi.org/10.1182/bloodadvances.2025018952