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

Niknejad, Bahar; Bolier, Ruth; Henderson, Charles R.; Delgado, Diana; Kozlov, Elissa; Löckenhoff, Corinna E.; Reid, M. Carrington

doi:10.1001/jamainternmed.2018.0756

Cited by 152Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Management and Opioid Use

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

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Niknejad, Bahar, Bolier, Ruth, Henderson, Charles R., Delgado, Diana, Kozlov, Elissa, Löckenhoff, Corinna E., Reid, M. Carrington·2018·JAMA Internal Medicine

DOI 10.1001/jamainternmed.2018.0756PMC PMC6145761

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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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Most studies of trauma-focused psychotherapies have focused on behavioural health outcomes such as PTSD symptomology, depression or anxiety.
“most studies of trauma-focused psychotherapies have focused on behavioural health outcomes such as PTSD symptomology, depression or anxiety [26,27].”
From Health care utilisation changes among Alaska Native adults after participation in an indigenous community programme to address adverse life experiences: a propensity score-matched analysis (2020) · cites this paper as [27]
The Methods sections on Eligibility Criteria and Outcomes (page numbers unavailable) describe CBT-based studies of chronic pain in older adults and include depression and anxiety among the outcomes assessed. Our copy does not address trauma-focused psychotherapy, PTSD outcomes, or whether most studies in that field focus on behavioural health outcomes (searched: trauma-focused psychotherapy and posttraumatic stress disorder). (LLM, conf=0.76)
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Authors: Niknejad, B., Bolier, R., Henderson, C. R., Delgado, D., Kozlov, E., Löckenhoff, C. E., & Reid, M. C.
Affiliations: Eastern Virginia Medical School (US)
Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
Cornell University (US)
Weill Cornell Medicine (US)
Corresponding author: Reid, M. Carrington
ORCID: Bolier, Ruth
Henderson, Charles R.
Delgado, Diana
Kozlov, Elissa
Löckenhoff, Corinna E.
Reid, M. Carrington
Venue: JAMA Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2018-06-01
Volume: 178
Issue: 6
Pages: 830
ISSN: 2168-6106 (ISSN-L)
DOI: 10.1001/jamainternmed.2018.0756
PMC: PMC6145761
OpenAlex: W2800336802
Cited by: 152
References: 78
Citations by year: 2026: 21 · 2025: 30 · 2024: 11 · 2023: 18 · 2022: 14 · 2021: 27 · 2020: 17 · 2019: 8 · 2018: 6
FWCI: 1.69
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Internal Medicine (publishedVersion)
California Medical Journal (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion, cc-by)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Funders: National Institute on Aging (T32AG049666, K24AG053462, P30AG022845)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: chronic non-cancer pain, older adults, psychological intervention, cognitive behavioral therapy, pain intensity, pain interference, depressive symptoms, anxiety, pain catastrophizing, pain self-efficacy, physical function, treatment effects, treatment moderators, treatment effect heterogeneity, treatment acceptability, methodological quality, physical health
MeSH terms: Aged, Humans, Cognitive Behavioral Therapy, Chronic Pain

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

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