Non-Pharmacological Interventions for Chronic Pain in Older Adults: A Systematic Review and Meta-Analysis

Author: Dara Kiu Yi Leung1, Annabelle Pui Chi Fong1, Frankie Ho Chun Wong1,2, Tianyin Liu1,3, Gloria Hoi Yan Wong1, Terry Yat Sang Lum1,4
1 Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China.
2 Philip Merrill College of Journalism, University of Maryland, College Park, Maryland, USA.
3 Department of Applied Social Sciences, The Polytechnic University of Hong Kong, Hung Hom, Hong Kong, China.
4 Sau Po Centre on Ageing, The University of Hong Kong, Pokfulam, Hong Kong, China.
Conference/Journal: Gerontologist
Date published: 2024 Feb 15
Other: Pages: gnae010 , Special Notes: doi: 10.1093/geront/gnae010. , Word Count: 257

Background and objectives:
Gate control theory and fear-avoidance model of chronic pain posit that biopsychosocial factors can modulate pain. Non-pharmacological 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 non-pharmacological intervention approaches for chronic pain management among older adults via meta-analysis and subgroup analysis.

Research design and methods:
Following the PRISMA guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to 21 March 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.

Twenty-five trials (N = 2394 participants) were identified. Six types of non-pharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Non-pharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms and catastrophizing beliefs and improvement in physical performance (standardized mean differences [SMDs] -0.34 to 0.54). Subgroup analyses based on different non-pharmacological approaches revealed the benefits of psychological approaches combined with physical activity.

Discussion and implications:
Non-pharmacological 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.

Keywords: Pain management; acupuncture; biopsychosocial; exercise; psychological.

PMID: 38366560 DOI: 10.1093/geront/gnae010