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Psychologist interventions can help chronic pain in older adults

By Bianca Nogrady
Psychological interventions such as cognitive behavioural therapy can reduce pain intensity and catastrophising in older adults with chronic pain, new research suggests.

A systematic review and meta-analysis looked at 22 randomised controlled trials, involving a total of 2608 participants aged 60 years or older, of psychological interventions for chronic pain.

The results, published in JAMA Internal Medicine, found the psychological interventions were associated with small but significant improvements in pain intensity – which persisted up to six months after the intervention – and reductions in catastrophising beliefs.

The approaches used in the various studies included behavioural coping skills training – muscle relaxation, activity-rest cycling, meditation and mindfulness – and cognitive coping skills training, which included visualisation and guided imagery. 

Some studies also investigated acceptance interventions, in which participants learned awareness of avoidance behaviours that aim to control pain, and strategies to minimise their reactivity to pain sensations. 

The analysis suggested that treatment differences were limited to – or at least stronger for – group therapy compared with individual therapy.

‘Potential mechanisms that could account for this finding include access to peer support, social facilitation of target behaviors, and public commitment to therapy goals,’ the authors wrote. 

Commenting on the study, clinical psychologist Professor Michael Nicholas said the findings offered reassurance that there were psychological treatments for chronic pain that were reasonably helpful; provided they were delivered to the standard and format of those included in the analysis. 

‘There are far too many treatments around where people have labelled them one thing or another and assumed that the label confers quality,’ said Professor Nicholas, from Royal North Shore Hospital and the Pain Management Research Institute at The University of Sydney.

Professor Nicholas told Pain Management Today that to be effective, psychological interventions needed to include cognitive behavioural pain management and education, as well as directed exercises. 

‘In chronic pain, the patient has to play an active role and the job of a therapist is to be more like a coach, to teach the patient what they can do for themselves,’ he said.
JAMA Intern Med 2018; 178: 830-839.