The Effectiveness of Cognitive and Behavioural Treatment of Chronic Pain in the Elderly: A Quantitative Review

Abstract

This study provides a meta-analytic review of cognitive and behavioural interventions for chronic pain in the elderly, focusing on treatment effectiveness. Included in the analysis are studies in which a comparison was made either to a control condition or to pre-treatment. A total of 12 outcome studies published or reported between January 1975 and March 2008, were identified involving participants 60 years and above and providing 16 separate treatment interventions. The analysis indicated that cognitive and behavioural interventions were effective on self-reported pain experience, yielding an overall effect size of 0.47. However, there were no significant effects of cognitive and behavioural treatment on symptoms of depression, physical functioning and medication use. Methodological issues concerning design, outcome measures and treatment are discussed and recommendations for future studies are outlined.

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

“…A review of the effectiveness of cognitive and behavioral treatment for chronic pain in older people concluded that, based on 16 separate treatment comparisons, these treatments produce a small or near medium sized effect on reported pain but no effect on depression, physical functioning, or medication use (14). More encouraging results were achieved in a more recent study by Nicholas and colleagues (6).…”

Functional Analysis With Typically Developing Children: Best Practice or Too Early to Tell?: In Response to Hanley (2012)

“…For example, in a review of the literature, McIntosh et al documented good agreement between a functional assessment interview and experimental methods. Rather than discounting closed-ended interviews and rating scales completely, practitioners should be aware that the reliability and validity of the assessment depends in large part on the skill of the assessor and on the knowledge and goals of the individual completing the rating scale or being interviewed (Haynes, Kaholokula, & Yoshioka, 2008;Lydon, Healy, O'Reilly, & Lang, 2012;Suen & Rzasa, 2004). Further, instruments should be used for the population for which they were intended.…”

“…This issue has been examined in the context of functional analysis in a handful of studies, almost exclusively with individuals with disabilities. Several studies have demonstrated differential outcomes across settings or therapists (Anderson & Long, 2002;English & Anderson, 2004;Gardner, Spencer, Boelter, Dubard, & Jennett, 2012 [working with typically developing individuals]; Lang et al, , 2009. Thomason-Sassi, Iwata, and Fritz (2011) attempted to clarify this issue with 6 individuals with developmental delay.…”

“…The effect size for such interventions is impressive (e.g., Haynes et al, 2008;Norton & Price, 2007;Olatunji, Cisler, & Deacon, 2010;Opriş et al, 2012). There are numerous examples of other multicomponent interventions developed without a preintervention functional assessment with documented effectiveness for problems including, but not limited to, depressive disorders (e.g., Cuijpers, Andersson, Donker, & van Straten, 2011;Hans & Hiller, 2013), pain management (e.g., Lunde, Nordhus, & Pallesen, 2009;Veehof, Oskam, Schreurs, & Bohlmeijer, 2011), and childhood conduct problems (Lee, Niew, Yang, Chen, & Lin, 2012;Maughan, Christiansen, Jenson, Olympia, & Clark, 2005). More often than not, these evidencebased interventions have an accompanying implementation manual.…”

“…1 In a comprehensive review of the functional analysis literature, Hanley, Iwata, and McCord (2003) reported that 91% of participants in published studies had developmental delay. Lydon, Healy, O'Reilly, and Lang (2012) reviewed studies using variations of traditional functional analysis methods (e.g., brief functional analysis) and reported that 81% of studies included individuals with developmental delay. To date there has not been a comprehensive review of the broader body of functional assessment literature.…”