BoriZafi “Overcoming Pain” Framework: Non-Pharmacological Interventions to Treat Sickle Cell Pain Crises in Adolescents

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Sickle cell pain crises (SCPC), characterized by severe, recurrent acute pain episodes from vasoocclusion, are the most common reason for emergency visits among adolescents living with sickle cell disease worldwide.This study aimed to identify safe and effective non-pharmacological interventions (NPIs) for SCPC management and develop an expert-informed framework, the BoriZafi framework, of safe and effective NPIs for SCPC management, to treat adolescents living in low-and middle-income countries (LMICs).A three-round Delphi process was conducted with a multidisciplinary, international team of expert healthcare providers and researchers with an average of 19 years of experience managing SCPC in adolescents.The Delphi panel comprised 20 multidisciplinary experts from both LMICs and high-income countries.After three rounds of consultations, experts recommended 31 NPIs (e.g.massage) and rejected 32 interventions (e.g.cold application) due to safety concerns and limited evidence of efficacy.Based on these findings, the BoriZafi framework was developed.After applying a tier system that considered evidence, effectiveness, evidence of efficacy, patient acceptability, patient/expert-reported effectiveness, and safety risk, only seven NPIs were categorized as recommended in the BoriZafi framework.The interventions are biofeedback-assisted relaxation, cognitive-behavioural therapy, guided imagery, massage, music, virtual reality and Yoga.The BoriZafi framework provides a clear guideline for safe and effective NPIs that adolescents in LMICs can use to manage SCPC.It emphasizes interventions to adopt and those to be avoided.This framework can be instrumental in creating educational resources and promoting the safe implementation of these expert-recommended interventions to improve pain management in this vulnerable population. Conflict of interest: COI declared -see note COI notes:

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