title: Self-management intervention for chronic pain in older adults: a randomised controlled trial.
abstract: This study compared an outpatient pain self-management (PSM) program, using cognitive-behavioural therapy and exercises, with 2 control conditions in 141 chronic pain patients aged > 65 years. Results immediately posttreatment indicated that relative to the Exercise-Attention Control (EAC) group, the PSM group was significantly improved on measures of pain distress, disability, mood, unhelpful pain beliefs, and functional reach. The mean effect size for these gains was 0.52 (range: 0.44-0.68). By 1-month follow-up, relative to the EAC group, the PSM group remained better on most measures. At the 1-month follow-up, relative to a Waiting List (usual care) (WL) group, the PSM group was significantly improved on measures of pain distress, disability, and unhelpful pain beliefs. The mean effect size for these variables was 0.69 (range: 0.56-0.83). Relative to the WL group, the EAC group made no significant gains on any of the measured variables. At 1-month follow-up, the mean proportion of reliably improved cases (across outcome variables) was 41% (range: 16-60%) for the PSM group, twice that of those who met this criterion in the 2 control conditions (and this difference was statistically significant). Similarly, significantly more (44%) of the PSM group (vs 22% and 20% for the control groups) achieved a clinically significant improvement on pain disability. In the short term at least, cognitive-behavioural therapy-based PSM was more effective than exercises and usual care.
authors.affiliation: Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia. michael.nicholas@sydney.edu.au
authors.forename: Michael K
authors.initials: MK
authors.lastname: Nicholas
authors.forename: Ali
authors.initials: A
authors.lastname: Asghari
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Blyth
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Wood
authors.forename: Robin
authors.initials: R
authors.lastname: Murray
authors.forename: Rebecca
authors.initials: R
authors.lastname: McCabe
authors.forename: Alan
authors.initials: A
authors.lastname: Brnabic
authors.forename: Lee
authors.initials: L
authors.lastname: Beeston
authors.forename: Mandy
authors.initials: M
authors.lastname: Corbett
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.forename: Sarah
authors.initials: S
authors.lastname: Overton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D059408:Pain Management; D012648:Self Care; D016896:Treatment Outcome