Self-management intervention for chronic pain in older adults: A randomised controlled trial

Abstract

This study compared an outpatient pain self-management (PSM) program, using cognitive-behavioural therapy and exercises, with 2 control conditions in 141 chronic pain patients aged > 65 years. Results immediately posttreatment indicated that relative to the Exercise-Attention Control (EAC) group, the PSM group was significantly improved on measures of pain distress, disability, mood, unhelpful pain beliefs, and functional reach. The mean effect size for these gains was 0.52 (range: 0.44-0.68). By 1-month follow-up, relative to the EAC group, the PSM group remained better on most measures. At the 1-month follow-up, relative to a Waiting List (usual care) (WL) group, the PSM group was significantly improved on measures of pain distress, disability, and unhelpful pain beliefs. The mean effect size for these variables was 0.69 (range: 0.56-0.83). Relative to the WL group, the EAC group made no significant gains on any of the measured variables. At 1-month follow-up, the mean proportion of reliably improved cases (across outcome variables) was 41% (range: 16-60%) for the PSM group, twice that of those who met this criterion in the 2 control conditions (and this difference was statistically significant). Similarly, significantly more (44%) of the PSM group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive-behavioural therapy-based PSM was more effective than exercises and usual care.

Treatment of Chronic Pain for Adults 65 and Over: Analyses of Outcomes and Changes in Psychological Flexibility Following Interdisciplinary Acceptance and Commitment Therapy (ACT)

“…More encouraging results were achieved in a more recent study by Nicholas and colleagues (6). They showed that in people age 65 and older (n = 141), cognitive behavioral therapy (CBT) plus exercise, relative to an exercise attention control, produced significant improvements in pain-related distress, disability, and physical performance at post treatment and a one-month follow-up.…”

A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

“…General health issues in an older population of chronic pain patients may compound the self-management of chronic pain. Nicholas et al [40] showed that in older chronic pain adults combining cognitive behavioral therapy based pain self-management and exercise was more effective than just the exercise alone.…”

New Developments in the Psychological Management of Chronic Pain

“…The changes that occur in chronic pain to the entire central nervous system and brain do not differentiate in any way between, for instance, the individual with diagnosed osteoarthritis or the individual with joint pain but no X-ray findings, nor between the individual with celiac disease and another with irritable bowel syndrome. 48 Although much research and clinical effort have focused on adults of working age with chronic pain, CBT has been applied to help children 18,49 and older adults, 50 and to those with pain at the end of life. [51][52][53][54] We suspect that clinicians and researchers will continue to apply the general principles of CBT to a wide range of pain-related disorders.…”