Long-term outcomes from training in self-management of chronic pain in an elderly population: a randomized controlled trial.
This study compares the outcomes, from pretreatment to 1-year follow-up, of an outpatient, CBT-based pain self-management program (PSM) that included exercises, pain education, and pain coping strategies, with a control condition (exercise-attention control, EAC) that included exercises and a control for the attention of the treatment team. We previously reported short-term results (to 1-month follow-up) from the same study. This new paper considers the important issue of maintenance of treatment-related gains. The participants (n = 141) were a heterogeneous sample of ambulant, community-dwelling older adult patients with chronic pain (mean age: 73.90 [6.5] years [range: 65-87 years]). The long-term results indicate the pain self-management program group achieved and maintained significantly better results than the exercise-attention control group on the primary outcome, pain-related disability, as well as on usual pain, pain distress, depression, and fear-avoidance beliefs. The mean effect size for these gains by the pain self-management program group over the exercise-attention control group was 0.37 (range: 0.29-0.45), which is in the small effect size range. While statistically and clinically meaningful, these findings do indicate some weakening in effects over time but not to a significant degree. The study has implications for the provision of pain management interventions for community-dwelling older adults with chronic pain.
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Michael K
MK
Nicholas
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.|School of Psychology, Shahed University, Tehran, Iran.
Ali
A
Asghari
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.|School of Public Health, Concord Clinical School, University of Sydney, Sydney, Australia.|Sax Institute, Sydney, Australia.
Fiona M
FM
Blyth
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Bradley M
BM
Wood
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Robin
R
Murray
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Rebecca
R
McCabe
ABC Consulting, Sydney, Australia.
Alan
A
Brnabic
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Lee
L
Beeston
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Mandy
M
Corbett
The George Institute, University of Sydney, Australia.
Catherine
C
Sherrington
Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, Sydney, Australia.
Sarah
S
Overton
D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000523:psychology* / Q000534:rehabilitation*; D004185:Disability Evaluation; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D017063:Outcome Assessment, Health Care; D010045:Outpatients; D059408:Pain Management; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D015203:Reproducibility of Results; D012648:Self Care / Q000379:methods*
Asghari A, Nicholas MK. Pain self-efficacy beliefs and pain behaviour: a prospective study. PAIN 2001;94:85–100.
Broderick JE, Keefe FJ, Bruckenthal P, Junghaenel DU, Schneider S, Schwartz JE, Kaell AT, Caldwell DS, McKee D, Reed S, Gould E. Nurse practitioners can effectively deliver pain coping skills training to osteoarthritis patients with chronic pain: a randomized, controlled trial. PAIN 2014;155:1743–54.
Brooks R, Rabin RE, De Charro F, editors. The measurement and validation of a health status using EuroQol-5D: a European perspective. Basel: Kluwer Academic Publishers, 2003.
Burns JW, Nielson WR, Jensen MP, Heapy A, Czlapinski R, Kerns RD. Does change occur for the reasons we think it does? A test of specific therapeutic operations during cognitive-behavioral treatment of chronic pain. Clin J Pain 2015;31:603–11.
Cohen J. Statistical power analysis for the behavioural sciences. 2nd ed. Hillsdale: Lawrence Erlbaum Associates, 1988.
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity a critical review of available methods. J Clin Epidemiol 2003;56:221–9.
Deyo RA, Battie M, Beurskens AJHM, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G. Outcome measures for low back pain research: a proposal for standardized use. Spine (Phila Pa 1976) 1998;23:2003–13.
Dominick CH, Blyth FM, Nicholas MK. Unpacking the burden: understanding the relationships between chronic pain and comorbidity in the general population. PAIN 2012;153:293–304.
Dworkin RH, Turk DC, Farrarc JT, Haythornthwaited JA, Jensen MP, Katze NP, Kernsf RD, Stuckig G, Allenh RR, Bellamyi N, Carrj DB, Chandlerk J, Cowanl P, Dionnem R, Galern BS, Hertzo S, Jadadp AR, Kramerq LD, Manningr DC, Martins S, McCormickt CG, McDermottu MP, McGrathv P, Quessyw S, Rappaporto BA, Robbins W, Robinson JP, Rothmany M, Royalz MA, Simono L, Staufferaa JW, Steinab W, Tollettac J, Wernickead J, Wittero J. Core outcome measures for chronic pain clinical trials: IMMPACT recommendations. PAIN 2005;113:9–19.
Ersek M, Turner JA, Cain KC, Kemp CA. Results of a randomized controlled trial to examine the efficacy of a chronic pain self-management group for older adults. PAIN 2008;138:29–40.
Flor H, Behle DJ, Birbaumer N. Assessment of pain-related cognitions in chronic pain patients. Behav Res Ther 1993;31:63–73.
Gueorguieva R, Krystal JH. Move over ANOVA. Progress in analysing repeated measures data and its reflection in papers published in the archives of general psychiatry. Arch Gen Psychiatry 2004;61:310–17.
Hanmer J, Lawrence WF, Anderson JP, Kaplan RM, Fryback DG. Report of nationally representative values for the non institutionalized US adult population for 7 health-related quality-of-life scores. Med Decis Making 2006;26:391–400.
Jensen MP, Strom SE, Turner JA, Romano JM. Validity of the sickness impact profile Roland scale as a measure of dysfunction in chronic pain patients. PAIN 1992;50:157–62.
KeefeFJ PL, Somers T, Shelby R, Wren AV. Psychosocial interventions for managing pain in older adults: outcomes and clinical implications. Br J Anaesth 2013;111:89–94.
Kendal PC, Marrs-Garcia A, Nath SR, Sheldrick RC. Normative comparison for the evaluation of clinical significance. J Consult Clin Psychol 1999;67:285–99.
Kori SH, Miller RP, Todd DD. Kinesiophobia: a new view of chronic pain behaviour. Pain Manag 1990;3:35–43.
Lorig K, Holman H. Self-management education: history, definition, outcomes, and mechanisms. An Behav Med 2003;26:1–7.
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression, anxiety and stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 1995;33:335–43.
Moore RA, Straube S, Eccleston C, Derry S, Aldington D, Wiffen P, Bell RF, Hamunen K, Phillips C, McQuay H. Estimate at your peril: imputation methods for patient withdrawal can bias efficacy outcomes in chronic pain trials using responder analyses. PAIN 2012;153:265–8.
Naylor MR, Keefe FJ, Brigidi B, Naud S, Helzer JE. Therapeutic interactive voice response therapeutic interactive voice response for chronic pain reduction and relapse prevention. PAIN 2008;134:335–45.
Nicholas MK, Asghari A, Blyth FM, Wood BM, Murray R, McCabe R, Brnabic A, Beeston L, Corbett M, Sherrington C, Overton S. Self-management intervention for chronic pain in older adults: a randomized controlled trial. PAIN 2013;154:824–35.
Nicholas MK, Asghari A, Blyth FM. What do the numbers mean? Normative data in chronic pain measures. PAIN, 2008;134:158–73.
Nicholas MK, Asghari A, Sharpe L, Brnabic A, Wood BM, Overton S, Tonkin L, de Sousa M, Finniss D, Beeston L, Sutherland A, Corbett M, Brooker C. Cognitive exposure versus avoidance in patients with chronic pain: adherence matters. Eur J Pain 2014;18:424–37.
Nicholas MK, Molloy AM, Tonkin L, Beeston L. Manage your pain. Sydney: ABC Books, 2007.
Nicholas MK. The pain self-efficacy questionnaire: taking pain into account. Eur J Pain 2007;11:153–63.
Park J, Hughes AK. Nonpharmacological approaches to the management of chronic pain in community-dwelling older adults: a review of empirical evidence. JAGS 2012;60:555–68.
Roland M, Morris R. A study of a natural history of the back pain. Part 1. Development of a reliable and sensitive measure of disability in low-back pain. Spine (Phila Pa 1976) 1983;8:141–4.
Saddiqui O, James HM, O'Neill R. MMRM vs. LOCF: a comprehensive comparison based on stimulation study and 25 NDA datasets. J Biopharm Stat 2009;19:227–46.
Somers TJ, Blumenthal JA, Guilak F, Kraus VB, Schmitt DO, Babyak MA, Craighead LW, Caldwell DS, Rice JR, McKee DC, Shelby RA, Campbell LC, Pells JJ, Sims EL, Queen R, Carson JW, Connelly M, Dixon KE, LaCaille LJ, Huebner JL, Rejeski WJ, Keefe FJ. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. PAIN 2012;153:1199–209.
Storey JE, Rowland JTJ, Conforti DA, Dickson HG. The Rowland Universal Dementia Assessment Scale (RUDAS): a multicultural cognitive assessment scale. Int Psychogeriatr 2004;16:13–31.
Sullivan MJA, Adams H, Ellis T. Targeting catastrophic thinking to promote return to work in individuals with fibromyalgia. J Cog Psychother 2012;26:130–42.
Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS, Hewitt DJ, Jadad AR, Katz NP, Kramer LD, Manning DC, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robinson JP, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Witter J. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. PAIN 2003;106:337–45.
Turner JA, Calysyn DA, Fordyce WE, Ready LB. Drug utilization patterns in chronic pain patients. PAIN 1982;12:357–63.
Turner JA. Research on cognitive-behavioral therapies for older adults with chronic pain: in its infancy, but growing. PAIN 2013;154:171–2.
Wideman TH, Adams H, Sullivan MJL. A prospective sequential analysis of the fear-avoidance model of pain. PAIN 2009;145:45–51.
Wideman TH, Sullivan MJ. Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers' compensation claimants. PAIN 2011;152:376–83.
Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. Assessing pain in older people with persistent pain: the NRS is valid but only provides part of the picture. J Pain 2010;11:1259–66.
Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. Catastrophizing mediates the relationship between pain intensity and depressed mood in older adults with persistent pain. J Pain 2013;14:149–57.
Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. The utility of the short version of the Depression Anxiety Stress Scales (DASS-21) in elderly patients with persistent pain: does age make a difference? Pain Med 2010;11:1780–90.
Yates SL, Morley S, Eccleston C, Williams AC. A scale for rating the quality of psychological trials for pain. PAIN 2005;117:314–25.