Pain self-management and exercise ‘effective in elderly’

By Joanna Lyford, Senior medwireNews Reporter

Techniques for the self-management of chronic pain based on cognitive behavioral therapy (CBT) significantly reduce disability, suggest results from a randomized controlled trial in older adults.

The short-term study found that an outpatient-based pain self-management (PSM) program, which included CBT and exercise, was more effective than exercise or usual care among older adults with chronic pain.

The trial included 141 patients aged 65 years and older who had been suffering from chronic non-cancer pain for at least 6 months. They were randomly assigned to one of three interventions: PSM, exercise control, or waiting list control.

The PSM program comprised eight 2-hour sessions at which patients received input from a psychologist about pain self-management and from a physiotherapist about exercise. The exercise group received only the physiotherapist input over the same eight 2-hour sessions, while the waiting list control received no treatment.

Between baseline and the end of treatment, patients in the PSM group showed significant improvements relative to the exercise group in measures of pain distress, disability, depression, fear-avoidance beliefs, catastrophizing, pain self-efficacy, and functional reach.

One month after the end of treatment, the PSM group continued to have significant improvements on measures of pain distress, disability, and unhelpful pain beliefs, relative to the exercise and usual-care groups.

Furthermore, the mean proportion of patients deemed to be "reliably improved" (ie, with greater-than-expected improvement across outcome variables) was 41% in the PSM group, versus 20% in the exercise group and 16% in the usual-care group.

Similarly, the proportion of patients who were considered to be "clinically improved" (ie, at least a 3-point increase in the measure of pain-related disability) was significantly higher in the PSM group than in the other two groups, at 44% versus 22% and 20%, respectively.

Writing in Pain, Michael Nicholas (University of Sydney at Royal North Shore Hospital, Australia) and fellow researchers say that their results indicate that combining CBT-based pain self-management and exercises is more effective than exercises alone and that exercises alone are no better than treatment as usual.

They also remark that very few randomized controlled trials have evaluated the use of CBT-based pain self-management in older people, a group that tends to have a high degree of comorbidity.

"The high satisfaction ratings, as well as low non-completion rates, support the potential for this type of treatment to be applied more widely in community settings," they conclude.

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