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Psychological interventions have benefits for chronic pain

Benefits are small but significant in treating chronic non-cancer pain in adults, analysis shows

Louise Prime

Wednesday, 09 May 2018

Psychological interventions to treat chronic non-cancer pain in older adults have small but significant benefits, although they don’t lead to a reduction in use of pain medication, according to a new analysis* published in JAMA Internal Medicine. The authors said they found that results were strongest when interventions were delivered using group-based approaches, and called for further research to develop and test strategies that enhance the efficacy of psychological approaches and sustainability of treatment effects in this group of patients.

Researchers from the US and a Netherlands department of general practice, said chronic non-cancer pain is common among older adults – but frequently, the drug therapies used to manage it have suboptimal outcomes. They added that pharmacological chronic pain management in older people is complicated by comorbidities and age-related physiologic changes. And although psychological treatments are recommended, there have been few data so far about their efficacy in older adults.

They conducted a systematic review and meta-analysis of 22 studies, with a total of 2,608 participants (of whom 69% were women; mean age 71.9 years), that had investigated whether or not older adults with chronic pain benefit from psychological therapies. In all of these studies the main outcome was pain intensity, but secondary outcomes included pain interference, depressive symptoms, anxiety, catastrophising beliefs, self-efficacy for managing pain, physical function, and physical health.

The researchers said their analysis showed that psychological interventions for chronic pain in older adults have “salutary, albeit small, benefits for treatment of pain, catastrophising beliefs, and self-efficacy”. However, they noted that the overall mean treatment results obscure variations at the individual patient level – so although some older patients with chronic pain might receive substantial benefit from psychological therapy, others might not benefit. They added that none of the studies reported any treatment-related reduction in pain medication use, including opioid use.

They concluded: “Psychological interventions for the treatment of chronic pain in older adults have small benefits, including reducing pain and catastrophising 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.”

* 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. JAMA Intern Med. Published online May 07, 2018. doi:10.1001/jamainternmed.2018.0756.

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