Activity

Activity ID

5834

Expires

June 4, 2021

Format Type

Journal-based CME

CME Credit

1

Fee

$30
CME Provider

JAMA Internal Medicine

Description
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.

Disclaimers
1. This activity is accredited by the American Medical Association.
2. This activity is free to AMA members.

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Commercial Support?
No

NOTE: If a Member Board has not deemed this activity for MOC approval as an accredited CME activity, this activity may count toward an ABMS Member Board’s general CME requirement. Please refer directly to your Member Board’s MOC Part II Lifelong Learning and Self-Assessment Program Requirements.

Educational Objectives

To determine the efficacy of psychological interventions in older adults with chronic pain and whether treatment effects vary by participant, intervention, and study characteristics.

Keywords

Geriatrics, Pain Medicine, Psychiatry, Psychotherapy, Rheumatology

Competencies

Medical Knowledge

CME Credit Type

AMA PRA Category 1 Credit

Additional Information

doi:10.1001/jamainternmed.2018.0756

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