Cognitive behavioral therapy-based psychological interventions — particularly those conducted in group sessions — may provide some benefits in older adults with chronic non-cancer pain, according to a study published in JAMA Internal Medicine.
For this systematic review and meta-analysis, investigators searched 4 databases, including Medline and Cochrane Library, to identify clinical trials assessing the use of psychological interventions in older adults with chronic pain.
Studies included in this analysis were randomized clinical trials that examined the use of cognitive behavioral therapy (alone or in combination with another approach) in adults age ≥60 with chronic pain (≥3 months) for whom pre- and post-treatment quantitative data were available.
Of the 2391 articles initially identified, 238 studies were reviewed for eligibility, 22 of which (n=2608; mean age, 71.9; 69% women) were selected for meta-analysis. The majority of interventions (mean length, 9.4 weeks; mean number, 8.4) were delivered in group sessions (15 studies) and in person (19 studies). Chronic pain (mean pain duration, 16.1 years) was categorized as musculoskeletal (17 studies), rheumatoid arthritis (1 study), mixed pain (4 studies), or other (5 studies).
Psychological interventions were found to improve pain intensity (21 studies; P =.006), pain catastrophizing (8 studies; P =.006), and pain self-efficacy (10 studies; P =.02) at treatment completion. At mid-term follow-up (between 12 and 24 weeks post-treatment), pain intensity was the only outcome improved by the psychological intervention (P =.002), and none of the outcomes evaluated persisted long-term (>24-week follow-up). Adverse events were reported in 3 studies and included transient increases in pain levels.
“The observed benefits were strongest when delivered using group-based approaches,” noted the review authors. “Potential mechanisms that could account for this finding include access to peer support, social facilitation of target behaviors, and public commitment to therapy goals,” they added.
“Research is needed to better understand the mechanisms responsible for the effects of psychological therapies on chronic pain and ways to augment these effects,” they concluded.
Niknejad B, Bolier R, Henderson CR, et al. Association between psychological interventions and chronic pain outcomes in older adults: A systematic review and meta-analysis [published online May 7, 2018]. JAMA Inter Med. doi:10.1001/jamainternmed.2018.0756