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Monday, November 18, 2019
Home Specialties Geriatrics Psych Interventions Control Pain in Older Adults

Psych Interventions Control Pain in Older Adults

Chronic pain is very common in older adults, and an issue that nurses have to work with when caring for patients in this population. Management can be complicated due to a number of issues, such as the presence of comorbid conditions and age-related physiologic changes. However, a new study has found that patients with noncancer chronic pain can benefit from psychological interventions.

What Does The Research Show?

While the benefit was small, it was statistically significant, demonstrating that psychological therapies can help reduce pain and catastrophizing beliefs, and improve self-efficacy for managing pain.

Managing pain in this population can be challenging for healthcare providers, due to comorbidities that limit treatment options, patient barriers such as fear of adverse effects from medications, health care professional barriers, as well as a limited evidence base to guide treatment. In addition, the ongoing opioid crisis has created its own set of challenges for chronic non-cancer pain management but at the same time, has stimulated increasing interest in nonpharmacologic therapies. 

The use of nonpharmacologic therapies to help manage pain is not a new concept, and these include a wide range of modalities such as behavioral approaches, meditation, relaxation techniques, physical therapy, aromatherapy, and chiropractic medicine. One approach that has garnered attention is the use cognitive behavioral therapy (CBT),  including cognitive and behavioral coping skills training, cognitive restructuring, and behavioral activation techniques.

Why Does This Matter?

CBT has been used for individuals with chronic pain and have demonstrated modest but statistically significant associations with pain, mood, and disability among adults with noncancer pain. Studies have also been investigating the use of nonpharmacologic pain management in older populations. Meanwhile, pain in older populations is a growing concern.

In the new paper published in JAMA Internal Medicine, researchers looked at the use of psychological interventions to help treat chronic pain in older adults. Researchers conducted a systematic review and meta-analysis of studies that evaluated a psychological intervention that used cognitive behavioral modalities alone or in combination with another strategy.

A total of 22 studies were included in their analysis, with a total of 2608 participants who had a mean age of 72 years. Most of the interventions were relatively short (mean length, 9.4 weeks; mean number, 8.4) and were given in group sessions (15 studies) and in person (19 studies). The mean duration of chronic pain reported by participants was 16.1 years, and categorized as musculoskeletal (17 studies), rheumatoid arthritis (1 study), mixed pain (4 studies), or other (5 studies).

The use of psychological interventions appeared to improve pain intensity (21 studies; P =.006), pain catastrophizing (8 studies; P =.006), and pain self-efficacy (10 studies; P =.02) by the end of the treatment. At a follow up time ranging between 12 and 24 weeks post-treatment, the intensity of pain was the only outcome that continued to show improvement by the psychological intervention (P =.002). None of the other outcomes that were evaluated persisted over the long term (>24-week follow-up).

“These benefits, which were documented at the completion of treatment, were found to persist up to 6 months later only for pain intensity reduction,” write the researchers. “Efforts are therefore needed to develop and test psychological interventions that generate more robust treatment effects that are sustainable in this growing population of patients.”

Last updated on 9/26/19.

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