TY - JOUR
T1 - Nonpharmacological Interventions for Chronic Pain in Older Adults
T2 - A Systematic Review and Meta-Analysis
AU - Leung, Dara Kiu Yi
AU - Fong, Annabelle Pui Chi
AU - Wong, Frankie Ho Chun
AU - Liu, Tianyin
AU - Wong, Gloria Hoi Yan
AU - Lum, Terry Yat Sang
N1 - Publisher Copyright:
© 2024 The Author(s).
PY - 2024/6/1
Y1 - 2024/6/1
N2 - Background and Objectives: Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. Research Design and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. Results: Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. Discussion and Implications: Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.
AB - Background and Objectives: Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Nonpharmacological interventions are recommended in managing chronic pain, but little information is available regarding their efficacy in older adults. We examined and compared the efficacy of different nonpharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis. Research Design and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 2022. Randomized controlled trials were included, and data were pooled using a random-effects meta-analysis model. Risk of bias was assessed using a quality rating scale for psychological interventions. Results: Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity. Discussion and Implications: Nonpharmacological interventions, particularly those adopting psychological approaches and physical activity, have a small but statistically significant effect on chronic pain management in older adults. Reduction in pain interference may be related to reduced catastrophizing beliefs, thus providing support for the fear-avoidance model. Further research with adequate power is needed to establish the efficacy and mechanism of various intervention modalities for older adults.
KW - Acupuncture
KW - Biopsychosocial
KW - Exercise
KW - Pain management
KW - Psychological
UR - http://www.scopus.com/inward/record.url?scp=85193646418&partnerID=8YFLogxK
U2 - 10.1093/geront/gnae010
DO - 10.1093/geront/gnae010
M3 - Journal article
C2 - 38366560
AN - SCOPUS:85193646418
SN - 0016-9013
VL - 64
JO - Gerontologist
JF - Gerontologist
IS - 6
M1 - gnae010
ER -