Journal of Clinical Psychology in Medical Settings

, Volume 16, Issue 3, pp 254–262

The Effectiveness of Cognitive and Behavioural Treatment of Chronic Pain in the Elderly: A Quantitative Review

  • Linn-Heidi Lunde
  • Inger Hilde Nordhus
  • Ståle Pallesen
Article

Abstract

This study provides a meta-analytic review of cognitive and behavioural interventions for chronic pain in the elderly, focusing on treatment effectiveness. Included in the analysis are studies in which a comparison was made either to a control condition or to pre-treatment. A total of 12 outcome studies published or reported between January 1975 and March 2008, were identified involving participants 60 years and above and providing 16 separate treatment interventions. The analysis indicated that cognitive and behavioural interventions were effective on self-reported pain experience, yielding an overall effect size of 0.47. However, there were no significant effects of cognitive and behavioural treatment on symptoms of depression, physical functioning and medication use. Methodological issues concerning design, outcome measures and treatment are discussed and recommendations for future studies are outlined.

Keywords

Cognitive behavioural interventions Chronic pain Elderly Meta-analysis 

References

References marked with an asterisk indicate studies included in the review.

  1. *Arena, J. G., Hannah, S. L., Bruno, G. M., & Meador, K. J. (1991). Electromyographic biofeedback training for tension headache in the elderly: A prospective study. Biofeedback and Self-Regulation, 16, 379–390.PubMedCrossRefGoogle Scholar
  2. *Arena, J. G., Hightower, N. E., & Chong, G. C. (1988). Relaxation therapy for tension headache in the elderly: A prospective study. Psychology and Aging, 3, 96–98.PubMedCrossRefGoogle Scholar
  3. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125–143.CrossRefGoogle Scholar
  4. Benca, R. M., Ancoli-Israel, S., & Moldofsky, H. (2004). Special considerations in insomnia diagnosis and management: Depressed, elderly, and chronic pain populations. Journal of Clinical Psychiatry, 65(Supplement 8), 26–35.PubMedGoogle Scholar
  5. Bradbeer, M., Helme, R. D., Yong, H. H., Kendig, H. L., & Gibson, S. J. (2003). Widowhood and other demographic associations of pain in independent older people. Clinical Journal of Pain, 19, 247–254.PubMedCrossRefGoogle Scholar
  6. Budiman-Mak, E., Conrad, K. J., & Roach, K. E. (1991). The foot function index: A measure of foot pain and disability. Journal of Clinical Epidemiology, 44, 561–570.PubMedCrossRefGoogle Scholar
  7. Butler, J., & Ciarrochi, J. (2007). Psychological acceptance and quality of life in the elderly. Quality of Life Research, 16, 607–615.PubMedCrossRefGoogle Scholar
  8. Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine Singapore, 23, 129–138.Google Scholar
  9. Cohen, J. (1977). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.Google Scholar
  10. *Cook, A. J. (1998). Cognitive-behavioural pain management for elderly nursing home residents. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 53, 51–59.Google Scholar
  11. Dahl, J. C., Wilson, K. G., Luciano, C., & Hayes, S. C. (2005). Acceptance and commitment therapy for chronic pain. Reno, NV: Context Press.Google Scholar
  12. Durlak, J. A., & Lipsey, M. W. (1991). A practitioner’s guide to meta-analysis. American Journal of Community Psychology, 19, 291–332.PubMedGoogle Scholar
  13. Dworkin, R. H., Turk, D. C., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Katz, N. P., et al. (2005). Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. Pain, 11, 9–19.CrossRefGoogle Scholar
  14. *Ersek, M., Turner, J. A., Cain, K. C., & Kemp, C. A. (2008). Results of a randomized controlled trial to examine the efficacy of a chronic pain self-management group for older adults. Pain, 138, 29–40.PubMedCrossRefGoogle Scholar
  15. *Ersek, M., Turner, J. A., McCurry, S., Gibbons, L., & Kraybill, B. M. (2003). Efficacy of a self-management group intervention for elderly persons with chronic pain. Clinical Journal of Pain, 19, 156–167.PubMedCrossRefGoogle Scholar
  16. *Fry, P. S., & Wong, P. T. P. (1991). Pain management training in the elderly: Matching interventions with subjects’ coping styles. Stress Medicine, 7, 93–98.CrossRefGoogle Scholar
  17. Gagliese, L., Katz, J., & Melzack, R. (1999). Pain in the elderly. In P. D. Wall & R. Melzack (Eds.), Textbook of pain (4th ed., pp. 991–1006). London: Churchill Livingstone.Google Scholar
  18. Gibson, S. J. (2003). Pain and aging: A comparison of the pain experience over the adult life span. In J. O. Dostrovsky, D. B. Carr, & M. Koltzenburg (Eds.), Proceedings of the 10th world congress on pain. Progress in pain research and management (Vol. 24, pp. 767–790). Seattle: IASP Press.Google Scholar
  19. Gibson, S. J. (2005). Age differences in psychosocial aspects of pain. In S. J. Gibson & K. Weiner (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 87–107). Seattle: IASP Press.Google Scholar
  20. Gibson, S. J. (2006). Older people’s pain. Pain, Clinical Updates, (vol. XIV). International Association for the Study of Pain, 3.Google Scholar
  21. Gloth, F. M. (2001). Principles of perioperative pain management in older adults. Clinics in Geriatric Medicine, 17, 553–573.PubMedCrossRefGoogle Scholar
  22. *Haas, M., Groupp, E., Muench, J., Kraemer, D., Brummel-Smith, K., Sharma, R., et al. (2005). Chronic disease self-management program for low back pain in the elderly. Journal of Manipulative and Physiological Therapeutics, 4, 228–237.CrossRefGoogle Scholar
  23. Hadjistavropoulos, T. (Ed). (2007). An interdisciplinary expert consensus statement on assessment of pain in older persons. Clinical Journal of Pain, 23(supplement).Google Scholar
  24. Hanlon, J. T., Guay, D. R. P., & Ives, T. J. (2005). Oral analgesics: Efficacy, mechanism of action, pharmacokinetics, adverse effects, drug interactions, and practical recommendations for use in older adults. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 205–222). Seattle: IASP Press.Google Scholar
  25. Hayes, S. C., & Duckworth, M. P. (2006). Acceptance and commitment therapy and traditional cognitive behavior therapy approaches to pain. Commentary. Cognitive and Behavioral Practice, 13, 185–187.CrossRefGoogle Scholar
  26. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behaviour change. New York: Guildford Press.Google Scholar
  27. Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. Orlando, FL: Academic Press.Google Scholar
  28. Helme, R. D., & Gibson, S. J. (2001). The epidemiology of pain in elderly people. Clinics in Geriatric Medicine, 17, 417–431.PubMedCrossRefGoogle Scholar
  29. Herr, K. A. (2005). Pain assessment in the older adult with verbal communication skills. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons. Progress in pain research and Management (Vol. 35, pp. 111–133). Seattle: IASP Press.Google Scholar
  30. Hofmann, S. G., & Asmundson, G. J. G. (2008). Acceptance and mindfulness-based therapy: New wave or old hat? Clinical Psychology Review, 28, 1–16.PubMedCrossRefGoogle Scholar
  31. Kabat-Zinn, J., Lipworth, L., & Burney, R. (1985). The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine, 8, 163–190.PubMedCrossRefGoogle Scholar
  32. *Kabela, E., Blanchard, E. B., Appelbaum, K. A., & Nicholson, N. (1989). Self-regulatory treatment of headache in the elderly. Biofeedback and Self-Regulation, 14, 219–228.PubMedCrossRefGoogle Scholar
  33. Keefe, F. J., Caldwell, D. S., Williams, D. A., Gil, K. M., Mitchell, D., Robertson, C., et al. (1990). Pain coping skills training in the management of osteoarthritic knee pain: A comparative study. Behavior Therapy, 21, 49–62.CrossRefGoogle Scholar
  34. Laidlaw, K., Thompson, L. W., Dick-Siskin, L., & Gallagher-Thompson, D. (2003). Cognitive behaviour therapy with older people (pp. 118–129). West Sussex, UK: Wiley.CrossRefGoogle Scholar
  35. McBee, L., Westreich, L., & Likourezos, A. A. (2004). A psychoeducational relaxation group for pain and stress management in the nursing home. Journal of Social Work in Long-Term Care, 3, 15–28.CrossRefGoogle Scholar
  36. McCracken, L. M., Carson, J. W., Eccleston, C., & Keefe, F. J. (2004). Acceptance and change in the context of pain. Pain, 109, 4–7.PubMedCrossRefGoogle Scholar
  37. McCracken, L. M., Gauntlett-Gilbert, J., & Vowles, K. E. (2007). The role of mindfulness in a contextual cognitive-behavioral analysis of chronic pain-related suffering and disability. Pain, 131, 63–69.PubMedCrossRefGoogle Scholar
  38. McCracken, L. M., Vowles, K. E., & Eccleston, C. (2005). Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase. Behaviour Research and Therapy, 43, 1335–1346.PubMedCrossRefGoogle Scholar
  39. Morley, S., Eccleston, C., & Williams, A. (1999). Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain, 80, 1–13.PubMedCrossRefGoogle Scholar
  40. *Morone, N. E., Greco, C., & Weiner, D. (2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain, 134, 310–319.PubMedCrossRefGoogle Scholar
  41. *Nicholson, N., & Blanchard, E. B. (1993). A controlled evaluation of behavioural treatment of chronic headache in the elderly. Behavior Therapy, 24, 395–408.CrossRefGoogle Scholar
  42. Nordhus, I. H., & Pallesen, S. (2003). Psychological treatment of late-life anxiety: An empirical review. Journal of Consulting and Clinical Psychology, 71, 643–651.PubMedCrossRefGoogle Scholar
  43. Pallesen, S., Mitsem, M., Kvale, G., Johnsen, B. H., & Molde, H. (2005). Outcome of psychological treatments for pathological gambling: A review and meta-analysis. Addiction, 100, 1412–1422.PubMedCrossRefGoogle Scholar
  44. Puder, R. S. (1988). Age analysis of cognitive-behavioural group therapy for chronic pain outpatients. Psychology and Aging, 3, 204–207.PubMedCrossRefGoogle Scholar
  45. *Reid, C. M., Otis, J., Barry, L. C., & Kerns, R. D. (2003). Cognitive-behavioural therapy for chronic low back pain in older persons: A preliminary study. Pain Medicine, 4, 223–230.PubMedCrossRefGoogle Scholar
  46. Robinson, L. A., Berman, J. S., & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychological Bulletin, 108, 30–49.PubMedCrossRefGoogle Scholar
  47. Schmader, K. E., & Dworkin, R. H. (2005). Clinical features and treatment of postherpetic neuralgia and peripheral neuropathy in older adults. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 355–375). Seattle: IASP Press.Google Scholar
  48. Scogin, F., & McElreath, L. (1994). Efficacy of psychosocial treatments for geriatric depression: A quantitative review. Journal of Consulting and Clinical Psychology, 62, 69–74.PubMedCrossRefGoogle Scholar
  49. Sharpe, L., Sensky, T., Timberlake, B. R., Ryan, B., Brewin, C. R., & Allard, S. (2001). A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: Preventing psychological and physical morbidity. Pain, 89, 275–283.PubMedCrossRefGoogle Scholar
  50. Turk, D. C., Dworkin, H., Revicki, D., Harding, G., Burke, L. B., Cella, D., et al. (2008). Identifying important outcome domains for chronic pain clinical trials: An IMMPACT survey of people with pain. Pain, 137, 276–285.PubMedCrossRefGoogle Scholar
  51. Vowles, K. E., McCracken, L. M., & Eccleston, C. (2007). Process of change in treatment for chronic pain: The contributions of pain, acceptance, and catastrophizing. European Journal of Pain, 11, 779–787.PubMedCrossRefGoogle Scholar
  52. Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483.PubMedCrossRefGoogle Scholar
  53. Waters, S. J., Woodward, J. T., & Keefe, F. J. (2005). Cognitive-behavioral therapy for pain in older adults. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 239–261). Seattle: IASP Press.Google Scholar
  54. Weiner, D. K. (1999). Assessing persistent pain in older adults: Practicalities and pitfalls. Analgesia, 4, 377–395.Google Scholar
  55. Weiner, D. K., & Cayea, D. (2005). Low back pain and its contributors in older adults: A practical approach to evaluation and treatment. In S. J. Gibson & D. K. Weiner (Eds.), Pain in older persons. Progress in pain research and management (Vol. 35, pp. 329–354). Seattle: IASP Press.Google Scholar
  56. Williams, A. C., & McCracken, L. M. (2004). Cognitive-behavioural therapy for chronic pain: An overview with specific reference to fear and avoidance. In G. J. Asmundson, J. W. S. Vlaeyen, & G. Crombez (Eds.), Understanding and treating fear of pain (pp. 293–312). Oxford. MA: Oxford University Press.Google Scholar
  57. Won, A. B., Lapane, K. L., Vallow, S., Schein, J., Morris, J. N., & Lipsitz, L. A. (2004). Persistent non-malignant pain and analgesic prescribing patterns in elderly nursing home residents. Journal of the American Geriatrics Society, 52, 867–874.PubMedCrossRefGoogle Scholar
  58. Woo, J., Ho, S. C., Lau, J., & Leung, P. C. (1994). Musculoskeletal complaints and associated consequences in elderly Chinese aged 70 and over. Journal of Rheumatology, 21, 1927–1931.PubMedGoogle Scholar
  59. World Health Organization (2008, October). Aging and life course. Retrieved October 6, 2008, from the WHO website: http://www.who.int/ageing/en/.

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Linn-Heidi Lunde
    • 1
    • 2
  • Inger Hilde Nordhus
    • 2
  • Ståle Pallesen
    • 3
  1. 1.The Pain ClinicHaukeland University HospitalBergenNorway
  2. 2.Department of Clinical PsychologyUniversity of BergenBergenNorway
  3. 3.Department of Psychosocial ScienceUniversity of BergenBergenNorway

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