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Association Between Psychological Interventions and Chronic Pain Outcomes in Older AdultsA Systematic Review and Meta-analysis

Educational 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.
1 Credit CME
Key Points

Question  Do older adults with chronic pain benefit from psychological therapies?

Findings  In this systematic review and meta-analysis including 22 studies with 2608 participants, psychological interventions that used cognitive behavioral therapy modalities were associated with statistically significant benefits in terms of reduced pain and catastrophizing beliefs as well as improved self-efficacy for managing pain. Benefits were small and documented at the time of treatment completion; with the exception of pain reduction, evidence is lacking for the persistence of observed benefits in other assessments conducted up to 6 months later.

Meaning  Among older adults with chronic pain, psychological therapies have a small, but statistically significant, benefit for reducing pain and catastrophizing beliefs and improving self-efficacy for managing pain.


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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Article Information

Accepted for Publication: January 31, 2018.

Corresponding Author: M. Carrington Reid, MD, PhD, Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY 10065 (

Published Online: May 7, 2018. doi:10.1001/jamainternmed.2018.0756

Author Contributions: Dr Reid had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Niknejad, Bolier, Henderson, Delgado, Kozlov, Reid.

Acquisition, analysis, or interpretation of data: Bolier, Henderson, Delgado, Kozlov, Löckenhoff, Reid.

Drafting of the manuscript: Niknejad, Bolier, Henderson, Delgado, Reid.

Critical revision of the manuscript for important intellectual content: Bolier, Henderson, Kozlov, Löckenhoff, Reid.

Statistical analysis: Henderson.

Administrative, technical, or material support: Niknejad, Bolier, Henderson, Delgado.

Study supervision: Bolier, Henderson, Reid.

Conflict of Interest Disclosures: None reported.

Funding/Support: Drs Löckenhoff and Reid are supported by Edward R. Roybal Translational Research on Aging award P30AG022845 from the National Institute on Aging. Dr Reid is also supported by National Institute on Aging award K24AGO53462, an investigator-initiated award from Pfizer Pharmaceuticals, and the Howard and Phyllis Schwartz Philanthropic Fund. Dr Kozlov is supported by National Institute on Aging grant T32AG049666.

Role of the Funder/Sponsor: The funders and sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data, preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or other funders.

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