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Original Investigation
June 2018

Association Between Psychological Interventions and Chronic Pain Outcomes in Older Adults: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Medicine, Eastern Virginia Medical School, Norfolk
  • 2GERION, Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
  • 3Department of Human Development, Cornell University, Ithaca, New York
  • 4Samuel J. Wood Library and C. V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York
  • 5Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
JAMA Intern Med. 2018;178(6):830-839. doi:10.1001/jamainternmed.2018.0756
Key Points

Question  Do older adults with chronic pain benefit from psychological therapies?

Findings  In this systematic review and meta-analysis including 22 studies with 2608 participants, psychological interventions that used cognitive behavioral therapy modalities were associated with statistically significant benefits in terms of reduced pain and catastrophizing beliefs as well as improved self-efficacy for managing pain. Benefits were small and documented at the time of treatment completion; with the exception of pain reduction, evidence is lacking for the persistence of observed benefits in other assessments conducted up to 6 months later.

Meaning  Among older adults with chronic pain, psychological therapies have a small, but statistically significant, benefit for reducing pain and catastrophizing beliefs and improving self-efficacy for managing pain.

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) characteristics with 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.

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