In older adults, psychological therapies have small benefits for treating chronic pain, review finds

Psychological interventions such as group therapy were associated with significant improvements in pain intensity and catastrophizing beliefs.

Psychological interventions, particularly group therapy, can reduce pain intensity and catastrophizing beliefs while increasing pain management skills in older adults with chronic noncancer pain, a recent systematic review and meta-analysis found.

Researchers analyzed 22 randomized trials including 2,608 participants with chronic pain, defined as pain for more than three months. Mean patient age was 71.9 years. Eligible studies had a sample mean age of 60 years or older, evaluated a psychological intervention for chronic pain that included cognitive behavioral therapy modalities alone or with another strategy (e.g., exercise), and reported quantitative data before and after the intervention.

The primary outcome was pain intensity. Secondary outcomes were pain interference, depressive symptoms, anxiety, catastrophizing beliefs, self-efficacy for managing pain, physical function, and physical health. Results were published online on May 7 by JAMA Internal Medicine.

The interventions resulted in significant improvements on the primary outcome and two secondary outcomes (differences of standardized mean differences, −0.181 for pain intensity [P=0.006], −0.184 for catastrophizing beliefs [P=0.046]; and 0.193 for self-efficacy [P=0.02]). These differences corresponded to a 0.49-point reduction in pain intensity on a scale of 0 to 10, a 0.32-point reduction in catastrophizing on a scale of 0 to 6, and a 4.11-point improvement in self-efficacy on a scale of 0 to 60.

For pain intensity only, the effect persisted up to six months after completion of treatment (difference of standardized mean difference, −0.251; P=0.002). Psychological interventions had no significant effect on the outcomes of pain interference, depressive symptoms, anxiety, physical function, and physical health.

Researchers examined 11 independent variables to assess whether certain participant, intervention, or study characteristics had an impact on treatment effects. Overall, only mode of therapy significantly affected results across most outcomes. For pain intensity, group therapy had more benefit than individual therapy (differences of standardized mean differences from baseline to postintervention, −0.202 [P=0.008] vs. −0.120 [P=0.38], respectively).

The study authors noted limitations, such as a lack of diversity in study populations (i.e., many patients were white and aged 65 to 74 years) and a lack of variability in intensity of the interventions across studies. In addition, few studies assessed outcomes more than six months after treatment completion, they added.

“Our results add to the existing literature by demonstrating that older adults—an understudied population with respect to the benefits of psychological therapies for chronic pain—can benefit from these treatment approaches. … Clinicians should learn and share with patients basic information about psychological approaches to managing pain,” the authors wrote.