Nonpharmacological Approaches to the Management of Chronic Pain in Community-Dwelling Older Adults: A Review of Empirical Evidence
ABSTRACT The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community-dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty-one studies (75%) identified in this review demonstrated statistically significant differences (P < .05) in pain scores between nonpharmacological interventions and no intervention or sham interventions; the intervention groups showed lower pain intensity. More research is needed to determine the best format, intensity, duration, and content of such treatments, as well as their efficacy in the older adult population. Methodological limitations are identified in many of the studies, such as low statistical power due to sample size and imprecise measurement, lack of reliable sham controls, and inadequate blinding. Future intervention studies of nonpharmacological pain therapies may require larger sample sizes, control for comorbidities, and long-term follow-up.
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ABSTRACT: Pain is a complex stressor that presents a significant challenge to most aspects of functioning and contributes to substantial physical, psychological, occupational, and financial cost, particularly in its chronic form. As medical intervention frequently cannot resolve pain completely, there is a need for management approaches to chronic pain, including psychological intervention. Psychotherapy for chronic pain primarily targets improvements in physical, emotional, social, and occupational functioning rather than focusing on resolution of pain itself. However, psychological therapies for chronic pain differ in their scope, duration, and goals, and thus show distinct patterns of treatment efficacy. These therapies fall into four categories: operant-behavioral therapy, cognitive-behavioral therapy, mindfulness-based therapy, and acceptance and commitment therapy. The current article explores the theoretical distinctiveness, therapeutic targets, and effectiveness of these approaches as well as mechanisms and individual differences that factor into treatment response and pain-related dysfunction and distress. Implications for future research, dissemination of treatment, and the integration of psychological principles with other treatment modalities are also discussed.Psychology Research and Behavior Management 04/2014; 7:115-124. DOI:10.2147/PRBM.S44762
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ABSTRACT: Nonpharmacological treatment of chronic pain in older people can be effective but attitudes and adherence to use of this treatment may differ by ethnicity. This study supports that a modified 14-item instrument based on the modified Health Belief Model-the arthritis-related health belief instrument (AHBI)-can be used across ethnically diverse older adults (i.e., European Americans, Hispanics, African Americans, and Afro-Caribbeans). Confirmatory factor analysis tested the factor structure of the AHBI to eliminate items inappropriate for this population. Structural equation modeling tested expected relationships among four latent variables-severity, susceptibility, barriers, and benefits-across the four ethnic groups. Findings suggest that the modified 14-item AHBI (eliminating two items from the original AHBI) adequately described the four latent factors pertaining to use of nonpharmacological pain therapy in this sample. All items registered substantial loadings (.41-.95) on the hypothesized factors, operating similarly across the four ethnic groups. The modified 14-item AHBI may be useful in (a) assessing how individual perceptions influence access to nonpharmacological pain therapy among ethnically diverse community-dwelling older adults, with the goal to develop and implement effective pain treatment for this population; and (b) measuring the likelihood of using nonpharmacological pain therapy by older adults. The modified 14-item AHBI can help health care providers to provide accurate pain assessment and examine domains that could affect use of nonpharmacological pain therapy by ethnically diverse older adults and guide practice with them by identifying barriers to use of such therapies and providing education to encourage their use.Journal of Community Health 06/2014; 40(1). DOI:10.1007/s10900-014-9898-7 · 1.28 Impact Factor
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ABSTRACT: Persistent pain is highly prevalent, costly, and frequently disabling in later life.JAMA The Journal of the American Medical Association 08/2014; 312(8):825-836. DOI:10.1001/jama.2014.9405 · 30.39 Impact Factor