Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults

Abstract

IMPORTANCE Chronic noncancer pain (hereafter referred to as chronic pain) is common among older adults and managed frequently with pharmacotherapies that produce suboptimal outcomes. Psychological treatments are recommended, but little information is available regarding their efficacy in older adults. OBJECTIVE To determine the efficacy of psychological interventions in older adults with chronic pain and whether treatment effects vary by participant, intervention, and study characteristics. DATA SOURCES MEDLINE, Embase, PsycINFO, and the Cochrane Library were searched from inception to March 29, 2017. STUDY SELECTION Analysis included studies that (1) used a randomized trial design,(2) evaluated a psychological intervention that used cognitive behavioral modalities alone or in combination with another strategy, (3) enrolled individuals with chronic pain (pain ≥3 months) with a sample mean age of 60 years or older, and (4) reported preintervention and postintervention quantitative data. DATA EXTRACTION AND SYNTHESIS Two of the authors independently extracted data. A mixed-model meta-analysis tested the effects of treatment on outcomes. Analyses were performed to investigate the association between participant (eg, age), intervention (eg, treatment mode delivery), and study (eg, methodologic quality) characteristicswith outcomes. MAIN OUTCOMES AND MEASURES Pain intensity was the primary outcome; secondary outcomes included pain interference, depressive symptoms, anxiety, catastrophizing beliefs, self-efficacy for managing pain, physical function, and physical health. RESULTS Twenty-two studies with 2608 participants (1799 [69.0%] women) were analyzed. Participants’ mean (SD) age was 71.9 (7.1) years. Differences of standardized mean differences (dD) at posttreatment were pain intensity (dD = −0.181, P = .006), pain interference (dD = −0.133, P = .12), depressive symptoms (dD = −0.128, P = .14), anxiety (dD = −0.205, P = .09), catastrophizing beliefs (dD = −0.184, P = .046), self-efficacy (dD = 0.193, P = .02), physical function (dD = 0.006, P = .96), and physical health (dD = 0.160, P = .24). There was evidence of effects persisting beyond the posttreatment assessment only for pain(dD = −0.251, P = .002). In moderator analyses, only mode of therapy (group vs individual) demonstrated a consistent effect in favor of group-based therapy. CONCLUSIONS AND RELEVANCE Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophizing beliefs and improving pain self-efficacy for managing pain. These results were strongest when delivered using group-based approaches. Research is needed to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects among older adults with chronic pain.

Characteristics and patterns of opioid-related overdoses among veterans

“…Similarly, those who experienced either a fatal index or repeat overdose were also more likely to have a chronic pain diagnosis prior to their index event, underscoring the need for integrated health care, which is consistent with other research findings [22,23] and supports the need for continued efforts to identify and support alternative approaches to management of chronic pain [62][63][64]. While the CDC has developed Chronic Pain Guidelines, these findings suggest the need to amplify risk management of chronic pain patients by additional education or co-prescription of naloxone [65].…”

“…Primary prevention strategies for opioid abuse and overdose prevention have largely focused on reducing the excess supply of prescription opioids, including the development and support of safe prescribing guidelines and the implementation of prescription drug monitoring programs (PDMP). Secondary and tertiary efforts have been primarily focused on addressing the gap in treatment and distribution of naloxone, a rapid acting opioid antagonist [63][64][65]. Importantly, one consequence of the increased distribution and resulting availability of naloxone is the associated increase in probability of surviving an overdose and related history of multiple overdoses.…”

“…In an effort to promote safer prescribing the VHA introduced the Opioid Safety Initiative (OSI) which leverages prescription data within the VHA and helps clinicians identify patients at risk for adverse risks from opioids. In addition to the OSI, the VHA developed a dashboard to identify patients at risk for an adverse event related to opioids [63,66]. Furthermore, the VHA has developed academic detailing on opioid abuse and overdose prevention in an effort to provide health care professionals with evidence-based educational tools [66].…”

Adaptability and Resilience in Aging Adults (ARIAA): A Pilot and Feasibility Study in Chronic Low Back Pain

“…Participants will be offered seven 1.5-hour group intervention sessions scheduled once weekly for seven weeks. This format was selected based upon the structure of prior clinical trials (37,38) and evidence that intervention effects on pain and psychological outcomes in older adults are strongest when delivered using group-based approaches (relative to an individual format) (39). To standardize the application of the intervention and to ensure treatment delity, the intervention will be manualized and will include interventionist and participant workbooks with materials (e.g., meditation CD) and handouts for discussion and home practice.…”

Positive Affect and Chronic Pain:A Preregistered Systematic Review and Meta-Analysis

“…1 With an increased prevalence among persons ages 65 and over, 2 chronic pain is a significant health burden-not just in terms of pain-related health care expenditures and disability, but also in terms of the inestimable costs to families and individual daily living and quality of life. Although there is increasing interest in the use of evidence-based non-pharmacological approaches to managing chronic pain, 3,4 standard behavioral therapies for chronic pain, such as cognitive-behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR), typically focus on targeting negative affective states (e.g., anxiety and depression) 5,6 and yield only modest treatment effects. 7,8 Efforts are therefore needed to develop more effective psychological treatments for chronic pain by identifying additional targets for intervention.…”