Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach

Yarns, Brandon C.; Zhu, Tongtong A.; Jazi, Ali Najafian

doi:10.1016/j.jagp.2022.07.009

Cited by 6 publications

(8 citation statements)

References 44 publications

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“…123 One instructive example is the role of emotional avoidance in certain types of chronic pain conditions, which often occur within the context of multimorbidity. 97 These chronic pain conditions, called centralized or nociplastic pain, are defined as pain without clear evidence of actual or threatened peripheral tissue or nervous system damage 124 and include musculoskeletal conditions such as nonspecific low back and neck pain, pelvic pain, temporomandibular disorders, tension headaches, fibromyalgia, as well as interstitial cystitis, irritable bowel syndrome, and othersall of which frequently co-occur. There is a strong link between childhood trauma, attachment problems, and these painful conditions.…”

Section: 'Negative' Psychological Factorsmentioning

confidence: 99%

“…96 The links between chronic pain and psychiatric disturbances have been extensively explored. 97,98 As another example, asthma is associated with anxiety, mood, substance use disorders, and dissociative and somatoform disorders. 85,99 There is evidence in multimorbidity research of certain disorders appearing in 'clusters', wherein one disorder increases the likelihood of having another.…”

Section: Psychiatric and Medical Multimorbiditymentioning

confidence: 99%

Section: Biologic Factors Underlying Multimorbiditymentioning

confidence: 99%

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Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity – the presence of two or more chronic conditions in an individual – which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors – including trauma and racism – that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.

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Section: 'Negative' Psychological Factorsmentioning

confidence: 99%

Section: Psychiatric and Medical Multimorbiditymentioning

confidence: 99%

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Managing medical and psychiatric multimorbidity in older patients

Carlson,

Yarns

2023

Therapeutic Advances in Psychopharmacology

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“…Em síntese, as intervenções farmacológicas desempenham um papel crucial no tratamento da dor crônica em idosos, mas a abordagem deve ser personalizada, considerando as características individuais e os desafios específicos dessa população. O equilíbrio entre eficácia e segurança é essencial para garantir resultados positivos e melhorar a qualidade de vida dos idosos com dor crônica (Yarns et al, 2022).…”

Section: Abordagem Farmacológicaunclassified

“…Essas modalidades visam proporcionar alívio da dor, melhorar a funcionalidade e promover o bem-estar, muitas vezes reduzindo a dependência de medicamentos. Uma revisão abrangente da literatura destaca várias terapias não farmacológicas empregadas nesse contexto (Yarns et al, 2022).…”

Section: Terapias Não Farmacológicasunclassified

Abordagens Multidisciplinares No Tratamento Da Dor Crônica Em Idosos: Uma Revisão Bibliográfica

Mainardo Rodrigues Bezerra,

Mendes dos Santos,

Felipe Venancio

et al. 2024

RECIMA21

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A dor crônica em idosos é prevalente e debilitante, exigindo abordagens terapêuticas multidisciplinares. A complexidade dessa condição é agravada por fatores como comorbidades, alterações fisiológicas e polifarmácia. Objetivo: Explorar abordagens multidisciplinares para o manejo da dor crônica em idosos, destacando benefícios, desafios e perspectivas futuras. Métodos: Uma revisão bibliográfica foi realizada, abrangendo estudos publicados nos últimos 15 anos sobre o tratamento multidisciplinar da dor crônica em idosos. Resultados e Discussão: A prevalência da dor crônica em idosos varia, afetando até 80% da população em alguns países. Impacta negativamente a qualidade de vida, sendo associada a limitações funcionais e emocionais. A avaliação diagnóstica requer uma abordagem abrangente, considerando comorbidades e escalas de avaliação validadas. O manejo terapêutico envolve intervenções farmacológicas e não farmacológicas, com ênfase na reabilitação, promoção do bem-estar e educação do paciente.Conclusão: A abordagem multidisciplinar é crucial no manejo da dor crônica em idosos, visando uma assistência integral e personalizada. Educação do paciente, estratégias de autogestão e promoção do bem-estar emocional são fundamentais para melhorar a qualidade de vida nessa população. Espera-se que este resumo contribua para a prática clínica e para uma melhor qualidade de vida dos idosos com dor crônica.

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Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

Yarns,

Jackson,

Alas

et al. 2024

JAMA Netw Open

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ImportanceChronic pain is common and disabling in older adults, and psychological interventions are indicated. However, the gold standard approach, cognitive-behavioral therapy (CBT), produces only modest benefits, and more powerful options are needed.ObjectivesTo evaluate whether emotional awareness and expression therapy (EAET) is superior to CBT for treatment of chronic pain among predominantly male older veterans and whether higher baseline depression, anxiety, or posttraumatic stress disorder (PTSD) symptoms—key targets of EAET—moderate treatment response.Design, Setting, and ParticipantsThis 2-arm randomized clinical trial was conducted from May 16, 2019, to September 14, 2023, in the US Department of Veterans Affairs Greater Los Angeles Healthcare System. The trial included a racially and ethnically diverse group of veterans aged 60 to 95 years with at least 3 months of musculoskeletal pain.InterventionsEmotional awareness and expression therapy or CBT, conducted concurrently, each presented as one 90-minute individual session followed by eight 90-minute group sessions.Main Outcomes and MeasuresThe primary outcome was Brief Pain Inventory pain severity (range, 0 to 10) from baseline to posttreatment (week 10, primary end point) and 6-month follow-up. Secondary outcomes included Patient Reported Outcomes Institute Measurement System Anxiety, Depression, Fatigue, General Life Satisfaction (NIH Toolbox), Pain Interference, and Sleep Disturbance Short Forms, Patient Global Impression of Change (PGIC), and Satisfaction with Therapy and Therapist Scale-Revised. A subset of participants completed the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). All analyses were for the intention-to-treat population and included all randomized participants.ResultsAmong 126 randomized participants (66 in the EAET group and 60 in the CBT group; mean [SD] age, 71.9 [5.9] years; 116 [92%] male), 111 (88%) completed posttreatment, and 104 (82%) completed the 6-month follow-up. The EAET was superior to CBT for the primary outcome of reduction in pain severity at posttreatment (estimate, −1.59 [95% CI, −2.35 to −0.83]; P &lt; .001) and follow-up (estimate, −1.01 [95% CI, −1.78 to −0.24]; P = .01). A greater percentage of participants in EAET vs CBT had clinically significant (at least 30%) pain reduction (63% vs 17%; odds ratio, 21.54 [95% CI, 4.66-99.56]; P &lt; .001) at posttreatment. In addition, EAET was superior to CBT on 50% pain reduction (35% vs 7%; odds ratio, 11.77 [95% CI, 2.38-58.25]; P = .002), anxiety (estimate, −2.49 [95% CI, −4.30 to −0.68]; P = .006), depression (estimate, −3.06 [95% CI, −5.88 to −0.25]; P = .03), general life satisfaction (estimate, 1.23 [95% CI, 0.36-2.10]; P = .005), PTSD symptoms (estimate, −4.39 [95% CI, −8.44 to −0.34]; P = .03), PGIC score (estimate, 1.46 [95% CI, 0.77-2.15]; P &lt; .001), and global treatment satisfaction (estimate, 0.28 [95% CI, 0.12-0.45]; P &lt; .001) at posttreatment. Higher baseline depression (estimate, −1.55 [95% CI, −0.37 to 2.73]; P &lt; .001), anxiety (estimate, −1.53 [95% CI, −2.19 to −0.88]; P &lt; .001), and PTSD symptoms (estimate, −1.69 [95% CI, −2.96 to −0.42]; P = .009) moderated greater reduction in pain severity after EAET but not CBT.Conclusions and RelevanceThe results of this randomized clinical trial suggest that EAET may be a preferred intervention for medically and psychiatrically complex patients with pain. The societal burden of chronic pain could be improved by further incorporating the principles of EAET into mainstream clinical pain medicine.Trial RegistrationClinicalTrials.gov Identifier: NCT03918642

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Chronic Pain in Older Adults: A Neuroscience-Based Psychological Assessment and Treatment Approach

Cited by 6 publications

References 44 publications

Managing medical and psychiatric multimorbidity in older patients

Managing medical and psychiatric multimorbidity in older patients

Abordagens Multidisciplinares No Tratamento Da Dor Crônica Em Idosos: Uma Revisão Bibliográfica

Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans

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