Progress in Geriatrics
Nonpharmacological Approaches to the Management of Chronic Pain in Community-Dwelling Older Adults: A Review of Empirical Evidence
Juyoung Park PhD,
Anne K. Hughes PhD,
Corresponding Author
Juyoung Park PhD
School of Social Work, Florida Atlantic University, Boca Raton, Florida
Address correspondence to Juyoung Park, Florida Atlantic University School of Social Work, 777 Glades Road, Boca Raton, FL 33431. E-mail: [email protected]Search for more papers by this authorAnne K. Hughes PhD
School of Social Work, Michigan State University, East Lansing, Michigan
Search for more papers by this authorJuyoung Park PhD,
Anne K. Hughes PhD,
Corresponding Author
Juyoung Park PhD
School of Social Work, Florida Atlantic University, Boca Raton, Florida
Address correspondence to Juyoung Park, Florida Atlantic University School of Social Work, 777 Glades Road, Boca Raton, FL 33431. E-mail: [email protected]Search for more papers by this authorAnne K. Hughes PhD
School of Social Work, Michigan State University, East Lansing, Michigan
Search for more papers by this authorAbstract
The objective of this literature review is to gain insight into the efficacy of nonpharmacological interventions in chronic pain management in community-dwelling older adults. An extensive search of pertinent databases was performed to identify reports of studies of nonpharmacological (physical and psychosocial) pain interventions. The review identifies intervention studies that used randomized controlled trials (RCTs) and summarizes existing evidence of effectiveness of nonpharmacological interventions. A literature search yielded 28 RCT intervention studies (18 for physical interventions and 10 for psychosocial interventions) that met inclusion criteria and are included in this review. Twenty-one studies (75%) identified in this review demonstrated statistically significant differences (P < .05) in pain scores between nonpharmacological interventions and no intervention or sham interventions; the intervention groups showed lower pain intensity. More research is needed to determine the best format, intensity, duration, and content of such treatments, as well as their efficacy in the older adult population. Methodological limitations are identified in many of the studies, such as low statistical power due to sample size and imprecise measurement, lack of reliable sham controls, and inadequate blinding. Future intervention studies of nonpharmacological pain therapies may require larger sample sizes, control for comorbidities, and long-term follow-up.
References
- 1 American Geriatrics Society. The management of persistent pain in older persons. J Am Geriatr Soc 2002; 50: S205–S224.
- 2 American Geriatrics Society (AGS), Panel on the Pharmacological Management of Persistent Pain. Pharmacological management of persistent pain in older persons. J Am Geriatr Soc 2009; 57: 1331–1346.
- 3Barkin RL, Barkin SJ, Barkin DS. Perception, assessment, treatment and management of pain in the elderly. Clin Geriatr Med 2005; 21: 465–490.
- 4Alexander LL. Palliative care and pain management at the end of life. CME Res 2009; 134: 61–109.
- 5Ettinger WH, Burns R, Messier SP et al. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: The Fitness Arthritis and Seniors Trial (FAST). JAMA 1997; 27: 25–31.
- 6Davis GC, White TL. A goal attainment pain management program for older adults with arthritis. Pain Manag Nurs 2008; 9: 171–179.
- 7Takeshima N, Rogers ME, Watanabe E et al. Water-based exercise improves health-related aspects of fitness in older women. Med Sci Sport Exer 2002; 34: 544–551.
- 8Nelson ME, Rejeski WJ, Blair SN et al. Physical activity and public health in older adults: Recommendation from the American college of sports medicine and the American Health Association. Circulation 2007; 116: 1–13.
- 9Melchart D, Linde K, Liao JK et al. Systematic clinical auditing in complementary medicine: Rationale, concepts, and a pilot study. Altern Ther Health Med 1997; 3: 33–39.
- 10Berman BM, Singh BB, Lao L et al. A randomized trial of acupuncture as an adjunctive therapy in osteoarthritis of the knee. Rheumatology 1999; 38: 346–354.
- 11Wright A, Sluka KA. Nonpharmacological treatments for musculoskeletal pain. Clin J Pain 2001; 17: 33–46.
- 12Podichetty VK, Mazance DJ, Biscup RS. Chronic non-malignant musculoskeletal pain in older adults: Clinical issues and opioid intervention. Postgrad Med J 2003; 79: 627–633.
- 13Grant D, Bishop-Miller J, Winchester D et al. A randomized comparative trial of acupuncture versus TENS for chronic back pain in the elderly. Pain 1999; 82: 9–13.
- 14Breit R, Van der Wall HD. Transcutaneous electrical nerve stimulation for postoperative pain relief after total knee arthroplasty. J Arthroplasty 2004; 19: 45–48.
- 15Ng MML, Leung MCP, Poon DMY. The effects of electro-acupuncture and transcutaneous electrical nerve stimulation on patients with painful osteoarthritic knees: A randomized controlled trial with follow-up evaluation. J Altern Complement Med 2003; 9: 641–649.
- 16Lee MS, Yang K, Huh H et al. Qi therapy as an intervention to reduce chronic pain and to enhance mood in elderly subjects: A pilot study. Am J Chinese Med 2001; 29: 237–245.
- 17Aung S. The clinical use of acupuncture in oncology: Symptom control. Acupunct Med 1994; 12: 37–40.
10.1136/aim.12.1.37 Google Scholar
- 18Wu WH, Bandilla E, Ciccone DS et al. Effects of qigong on late-stage complex regional pain syndrome. Altern Ther Health Med 1999; 5: 45–54.
- 19Carrington RM, Papaleontiou M, Ong A et al. Self-management strategies to reduce pain and improve function among older adults in community settings: A review of the evidence. Pain Med 2008; 9: 409–424.
- 20Eccleston C, Williams AC, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2009; 2: CD007407.
- 21Zhang GG, Lee W, Bausell B et al. Variability in the traditional Chinese medicine (TCM) diagnoses and herbal prescriptions provided by three TCM practitioners for 40 patients with rheumatoid arthritis. J Altern Complement Med 2005; 11: 415–421.
- 22Roberto KA, Perkins SN, Holland AK. Research on persistent pain in late life: Current topics and challenges. J Women Aging 2007; 19: 5–19.
- 23Kovar PA, Allegrante JP, MacKenzie R et al. Supervised fitness walking in patients with osteoarthritis of the knee: A randomized, controlled trial. Ann Intern Med 1992; 116: 529–534.
- 24Agre JC, Pierce LE, Raab DM et al. Light resistance and stretching exercise in elderly women: Effect upon strength. Arch Phys Med Rehabil 1988; 69: 273–276.
- 25Ferrell BA, Josephson KR, Pollan AM et al. A randomized trial of walking versus physical methods for chronic pain management. Aging 1997; 9: 99–105.
- 26Hughes SL, Seymour RB, Campbell R et al. Impact of the fit and strong intervention on older adults with osteoarthritis. Gerontologist 2004; 44: 217–228.
- 27Hughes SL, Seymour RB, Campbell RT et al. Long-term impact of fit and strong on older adults with osteoarthritis. Gerontologist 2006; 46: 801–814.
- 28Schilke JM, Johnson GOL, Housh TJ et al. Effects of muscle-strength training on the functional status of patients with osteoarthritis of the knee joint. Nurs Res 1996; 45: 68–72.
- 29Meng CF, Wang D, Ngeow J et al. Acupuncture for chronic low back pain in older patients: A randomized, controlled trial. Rheumatology 2003; 42: 1508–1517.
- 30Foster NE, Thomas E, Barlas P et al. Acupuncture as an adjunct to exercise based physiotherapy for osteoarthritis of the knee: Randomised controlled trial. BMJ 2007; 335: 1–2.
- 31Berman BM, Lao L, Langenberg P et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: A randomized, controlled trial. Ann Intern Med 2004; 141: 901–910.
- 32Foster NE, Thomas E, Hill JC et al. The relationship between patient and practitioner expectations and preferences and clinical outcomes in a trial of exercise and acupuncture for knee osteoarthritis. Eur J Pain 2010; 14: 402–409.
- 33Ga H, Choi JH, Park CH et al. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients: A randomised trial. Acupunct Med 2007; 25: 130–136.
- 34Manheimer E, Cheng K, Linde K et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev 2010; 1: CD001977.
- 35Trott PV, Wiedemann AM, Lǘdtke R et al. Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): A randomized controlled study. J Pain 2009; 10: 501–508.
- 36Yang K, Kim Y. Efficacy of qi-therapy (external qigong) for elderly people with chronic pain. Int J Neurosci 2005; 115: 949–963.
- 37Berman RLH, Iris MA, Bode R et al. The effectiveness of an online mind-body intervention for older adults with chronic pain. J Pain 2009; 10: 68–79.
- 38Ersek M, Turner J, McCurry S et al. Efficacy of a self-management group intervention for elderly persons with chronic pain. Clin J Pain 2003; 19: 156–167.
- 39Ersek M, Turner JA, Cain KC et al. Results of a randomized controlled trial to examine the efficacy of a chronic pain self-management group for older adults. Pain 2008; 128: 29–40.
- 40Haas M, Groupp E, Muench J et al. Chronic disease self-management program for low back pain in the elderly. J Manip Physiol Ther 2005; 28: 228–237.
- 41Rybarczyk B, DeMarco G, DeLaCruz M et al. A classroom mind-body wellness intervention for older adults with chronic illness: Comparing immediate and one-year benefits. Behav Med 2001; 27: 15–27.
- 42Green SM, Hadjistavropoulos T, Hadjistavropoulos H et al. Controlled investigation of a cognitive behavioural pain management program for older adults. Behav Cogn Psychother. 2009; 37: 221–226.
- 43Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain 2008; 134: 310–319.
- 44Morone NE, Rollman BL, Moore CG et al. A mind-body program for older adults with chronic low back pain: Results of a pilot study. Pain Med 2009; 10: 1395–1407.
- 45McCaffrey R, Freeman E. Effect of music on chronic osteoarthritis pain in older people. J Adv Nurs 2003; 44: 517–524.
- 46Baird CL, Sands L. A pilot study of the effectiveness of guided imagery with progressive muscle relaxation to reduce chronic pain and mobility difficulties of osteoarthritis. Pain Manag Nurs 2004; 5: 97–104.
- 47Melzack R, Katz J. The McGill Pain Questionnaire: Appraisal and current status. In: CC Turk, R Melzack, eds. Handbook of Pain Assessment. New York, NY: Guilford, 1992, pp 152–168.
- 48Bates MS, Rankin-Hill L. Control, culture and chronic pain. Soc Sci Med 1994; 39: 629–645.
- 49 National Center for Complementary and Alternative Medicine. What is complementary and alternative medicine (CAM)? 2002 [on-line]. Available at www.nccam.nih.gov/health/whatiscam/. Accessed July 4, 2011.
