A Multimodal Interventions for Managing Chronic Pain in Older Adults: A Randomized Controlled Trial in Primary Health Care Settings.

Chronic lower back pain prevalence is greatest among older adults. Older adults (65+) often have multiple comorbidities and are more likely to have high-impact chronic pain that significantly impacts daily activities and function. Owing to greater pain burden, older adults are prime candidates for low-risk, in-home pain treatment. The goal of the present study was two-fold: (1) to examine clinical effectiveness of an FDA-Authorized Skills-Based Virtual Reality delivered therapy for chronic lower back pain in adults (18–64) and older adults (65+) by conducting a secondary analysis of a randomized controlled trial (N = 505), and (2) to examine engagement rates with the Skills-Based Virtual Reality delivered therapy in adults and older adults in the randomized controlled trial sample, and a separate real-world clinical sample (N = 2460). The clinical effectiveness analysis found that adults and older adults with chronic lower back pain showed statistically equivalent and clinically meaningful reductions in pain intensity and pain interference that were durable to 12-months post-treatment along with parallel improvements in sleep, depression, and physical disability. Adult and older adult high-impact chronic pain patients showed greater pain reductions than lower impact chronic pain patients with the majority shifting to lower impact chronic pain status at end-of-treatment that was maintained at 12-months post-treatment. VR program engagement analysis showed that older adults evidenced higher engagement in VR relative to adults in both the randomized controlled trial and real-world clinical sample. Together these results challenge common misperceptions about older adults and suggest that this Skills-Based VR therapy is an accessible solution for chronic lower back pain in older adults that leads to strong clinical outcomes and high VR program engagement.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT05263037.

With South Korea’s elderly population projected to reach 20.6% by 2025 and 46.4% by 2070, managing chronic pain in older adults has become essential due to its impact on mood disorders such as depression and anxiety, which reduce quality of life. This growing demographic shift necessitates a transition from institutional care to home-based healthcare services. A single-group pre- and post-survey was conducted among 91 out of 128 individuals who received home-based traditional Korean medicine (TKM) services in 16 regions participating in the government community care pilot project and consented to participate in the survey. Among them, 46 individuals who completed both pretreatment and posttreatment surveys were included in the final analysis. Participants consisted of 17 men (37.0%) and 29 women (63.0%), with a mean age of 76.3 ± 10.2 years. Data were collected through online surveys before and after treatment, measuring pain levels using the numeric rating scale, condition-specific indices including the Oswestry Disability Index for back pain, Shoulder Pain and Disability Index for shoulder pain, and Western Ontario and McMaster Universities Osteoarthritis Index for knee pain. Quality of life was assessed using the EQ-5D. Participants experienced significant reductions in pain intensity (Numeric Rating Scale: 7.61 ± 1.73–4.67 ± 1.76, P < .001) and improvements in quality of life (EQ-5D: 0.472 ± 0.281–0.602 ± 0.237, P < .001) after receiving TKM care. Condition-specific analysis revealed a notable decrease in Oswestry Disability Index scores (0.610 ± 0.192–0.477 ± 0.201, P < .001) and Shoulder Pain and Disability Index scores (0.696 ± 0.108–0.477 ± 0.162, P < .001). However, Western Ontario and McMaster Universities’ Osteoarthritis Index scores for knee pain showed no significant improvement (86.1 ± 12.7–75.4 ± 19.7, P > .05). Home-based TKM care demonstrated effectiveness in alleviating chronic musculoskeletal pain and enhancing quality of life among older adults. These findings support integrating TKM into community care programs targeting South Korea’s aging population. Further large-scale studies are recommended to validate these results and explore the potential mental health benefits of such interventions.

BACKGROUND Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. OBJECTIVE The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. METHODS This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. RESULTS A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality–based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants’ engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. CONCLUSIONS Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. INTERNATIONAL REGISTERED REPORT RR2-10.1101/2023.07.27.23293235

Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality-based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants' engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. RR2-10.1101/2023.07.27.23293235.

Chronic pain in older adults represents a major public health concern, with non-pharmacological interventions gaining importance as a key strategy for pain management. Social support, positive and negative affect, and pain catastrophizing are known to be associated with pain intensity in older adults. This study aimed to investigate the effect of social support on pain intensity in older adults with chronic pain and to explore the mediating roles of positive affect, negative affect, and pain catastrophizing. This cross-sectional study involved 363 older adults with chronic pain who completed the Social Support Rating Scale (SSRS), Positive and Negative Affect Scale (PANAS), Pain Catastrophizing Scale (PCS), and Numeric Rating Scale (NRS). Serial mediation analysis was conducted to test whether positive and negative affect and pain catastrophizing act sequentially as mediators between social support and pain intensity. Structural equation modeling (SEM) was conducted using Mplus 8.3 to examine whether positive and negative affect and pain catastrophizing serially mediate the association between social support and pain intensity. Social support was negatively associated with pain intensity, both directly and indirectly, through the separate mediating effects of positive affect (β = -0.129, 95% CI: -0.176, -0.082) and pain catastrophizing (β = -0.199, 95% CI: -0.262, -0.136). The sum of these indirect effects accounted for 49.84% of the total effect. Furthermore, social support was indirectly associated with reduced pain intensity via the serial mediation of negative affect and pain catastrophizing (β = -0.088, 95% CI: -0.131, -0.059) and the serial mediation of positive affect and pain catastrophizing (β = -0.066, 95% CI: -0.099, -0.043). These pathways collectively accounted for 23.40% of the total effect. Healthcare providers (e.g., nurses, physicians, and therapists) should enhance chronic pain management by assessing patients' social support levels and implementing interventions focused on emotional regulation and cognitive restructuring. An interdisciplinary approach is recommended to effectively reduce pain intensity in older adults. Not applicable.

Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. This 24-month prospective cohort study included older adults aged 65years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027). Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

Chronic pain in older adults is a serious and debilitating issue, often overlooked and mismanaged by primary care physicians. Chronic pain affects 25-50% of community dwelling older adults, and 45-80% of older adults residing in long-term care facilities. Exercise in geriatric populations is necessary to maintain mobility and quality of life. We analyzed 129 Veterans at the Miami VA Medical Center who were enrolled in an evidence based exercise program. The objective of this study was to determine the impact of an evidence-based exercise program on chronic pain in the older adults of South Florida.

Chronic pain occurs in 30% of older adults. This prevalence rate is expected to increase, given the growth in the older adult population and the associated growth of chronic conditions contributing to pain. No population-based studies have provided detailed, longitudinal information on the experience of chronic pain in older adults; the pharmacological and nonpharmacological strategies that older adults use to manage their chronic pain; and the effect of chronic pain on patient-reported outcomes. This article aims to describe the protocol for a population-based, longitudinal study focused on understanding the experience of chronic pain in older adults. The objectives are to determine the prevalence and characteristics of chronic pain; identify the pharmacological and nonpharmacological pain treatments used; evaluate for longitudinal differences in biopsychosocial factors; and examine how pain types and pain trajectories affect important patient-reported outcomes. Also included are the results of a pilot study. A population-based sample of approximately 1,888 older adults will be recruited from the National Opinion Research Center at the University of Chicago's AmeriSpeak Panel to complete surveys at three waves: enrollment (Wave 1), 6 months (Wave 2), and 12 months (Wave 3). To determine the feasibility, a pilot test of the enrollment survey was conducted among 123 older adults. In the pilot study, older adults with chronic pain reported a range of pain conditions, with osteoarthritis being the most common. Participants reported an array of pharmacological and nonpharmacological pain strategies. Compared to participants without chronic pain, those with chronic pain reported lower physical and cognitive function and poorer quality of life. Data collection for the primary, longitudinal study is ongoing. This project will be the first longitudinal population-based study to examine the experience and overall effect of chronic pain in older adults. Pilot study results provide evidence of the feasibility of study methods. Ultimately, this work will inform the development of tailored interventions for older patients targeted to decrease pain and improve function and quality of life.

PurposeOlder adults are referred for outpatient physical therapy to improve their functional capacities. The goal of the present study was to determine if pain had an influence on functional outcomes in older adults who took part in an outpatient physical rehabilitation program.Patients and MethodsA retrospective study was performed on the medical records of patients aged 65 and over referred for outpatient physical therapy to improve physical functioning (n=178). Pain intensity (11-point numeric pain scale) and results from functional outcome measures (Timed Up and Go [TUG], Berg Balance Scale [BBS], 10-meter walk test, 6-minute walk test and Functional Autonomy Measuring System [SMAF]) were extracted at initial (T1) and final (T2) consultations. Paired t-tests were performed to determine if there were differences in functional outcome measures between T1 and T2 in all the patients. Patients were stratified to those with pain (PAIN, n=136) and those without pain (NO PAIN, n=42). Differences in functional outcome measures between T1 and T2 (delta scores) were compared between groups with independent t-tests with Welch corrections for unequal variances. Pearson correlation coefficients between initial pain intensity and changes in functional outcome measures (T2-T1) were also performed. Correcting for multiple comparisons, a p-value of p≤0.01 was considered as statistically significant.ResultsThe TUG, BBS, 10-meter walk test, 6-minute walk test all demonstrated improvement between T1 and T2 (all p<0.01). There was no difference between groups for delta scores for TUG (p=0.14), BBS (p=0.03), 10-meter walk test (p=0.54), 6-minute walk test (p=0.94) and SMAF (p=0.23). Pearson correlation coefficients were weak between initial pain intensity and changes in functional outcome scores between T1 and T2 (r= −0.16 to 0.15, all p-values >0.10).ConclusionThese results suggest that pain is not an impediment to functional improvements in older individuals who participated in an outpatient physical rehabilitation program.

To characterize relationships between self-reported co-morbidity and functional outcomes in community-dwelling older adults, and to assess whether the impact of co-morbidity persists even after adjustment for baseline functional status. Prospective observational study. We examined associations between self-reported co-morbidity at baseline and functional outcomes at one year, with and without adjustment for baseline functional status. Outpatient clinics at a managed care and a Veterans Affairs site. Four hundred and fifty-seven community-dwelling older adults representing a broad spectrum of overall health status. (a) New basic ADL (activities of daily living) problem during follow-up; (b) 10-point decline in the physical function index of the MOS-36 (MOS-PFI). Co-morbidity was associated with adverse functional outcomes in bivariable analyses. After adjustment for age and baseline functional status, an accumulated co-morbidity score provided additional explanatory power for predicting new ADL problems; odds ratios were 2.30 (1.09, 5.09) and 2.96 (1.48, 6.25) for 2 and > or = 3 affected co-morbidity domains, respectively. The impact of baseline status was also important; odds ratios for new ADL problems were 4.77 (2.68, 8.81) when at least one instrumental activity of daily living (IADL) problem was present at baseline, and 15.6 (8.05, 31.3) when at least one basic ADL problem was present at baseline. Accumulated self-reported co-morbidity has significant negative effects on function at one year; these effects are attenuated but not eliminated by adjustment for baseline status. Co-morbidity adjustment is probably an important design element in clinical research focused on functional outcomes in older adults.

We conducted a structured review of eight mind-body interventions for older adults with chronic nonmalignant pain. To evaluate the feasibility, safety, and evidence for pain reduction in older adults with chronic nonmalignant pain in the following mind-body therapies: biofeedback, progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga. Relevant studies in the MEDLINE, PsycINFO, AMED, and CINAHL databases were located. A manual search of references from retrieved articles was also conducted. Of 381 articles retrieved through search strategies, 20 trials that included older adults with chronic pain were reviewed. Fourteen articles included participants aged 50 years and above, while only two of these focused specifically on persons aged >or=65 years. An additional six articles included persons aged >or=50 years. Fourteen articles were controlled trials. There is some support for the efficacy of progressive muscle relaxation plus guided imagery for osteoarthritis pain. There is limited support for meditation and tai chi for improving function or coping in older adults with low back pain or osteoarthritis. In an uncontrolled biofeedback trial that stratified by age group, both older and younger adults had significant reductions in pain following the intervention. Several studies included older adults, but did not analyze benefits by age. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly associated with pain reduction in these studies. The eight mind-body interventions reviewed are feasible in an older population. They are likely safe, but many of the therapies included modifications tailored for older adults. There is not yet sufficient evidence to conclude that these eight mind-body interventions reduce chronic nonmalignant pain in older adults. Further research should focus on larger, clinical trials of mind-body interventions to answer this question.

Background Chronic musculoskeletal pain is a key societal challenge in Ireland, affecting one in three adults over the age of 50, with societal and healthcare costs of over €5.34 billion per year. Physical activity can form a key part of the management of people living with chronic pain, along with providing a myriad of health-enhancing and disease-prevention benefits for older adults. However, pain can limit engagement in physical activity, leading to the negative effects of chronic pain in older adults. Public and Patient involvement in this study identified that people with chronic pain fear exacerbation of their symptoms with exercise, and value having an experienced exercise leader who understands their needs. The primary aim of this study was to examine the feasibility and acceptability of a community-based exercise intervention, ComEx Pain, specifically tailored to older adults with chronic musculoskeletal pain. This paper reports a protocol designed to evaluate the feasibility of conducting a two-arm randomized controlled trial (RCT). Methods ComEx Pain is a randomised controlled feasibility trial with embedded economic and process evaluations. Community-dwelling adults aged ≥50 years living with chronic musculoskeletal pain will be recruited in the mid-western region of Ireland. Randomisation will be conducted using a 1:1 allocation ratio into two groups: (1) an intervention group receiving a community-based exercise program led by trainers educated in supporting people with chronic pain and (2) a control group who will receive a paper-based education manual. Primary outcomes for feasibility include recruitment rate, retention rate, and adherence to the intervention. The secondary outcomes will include changes in pain, physical function, emotional function, and physical activity. Discussion If this pilot feasibility study finds evidence to support feasibility and acceptability, a future larger-scale definitive trial will be conducted to examine the effectiveness of ComEx Pain in older adults living with chronic musculoskeletal pain. Trial registration number: Registered at Clinical Trials.gov NCT06535633.

Over 100 million Americans experience chronic pain (i.e., pain lasting three or more months), with older adults being disproportionately affected. However, the pattern of pain locations and impact of chronic pain in much older adults have not been well-studied. Further, chronic pain itself has been associated with higher risk of mortality; thus, surviving older adults may report less pain. Greater extent of pain locations, characterized by chronic multisite (≥ 3 pain sites) and chronic widespread pain (WSP, bilateral pain above and below the waist and in the spine), is associated with worse quality of life (QOL) and more severe and activity-interfering pain. Whether these patterns hold true for much older adults is unclear. Using a large, cross-sectional, community-based sample of older adults from the Framingham Heart Study (N = 1,584; mean age, 76.1 ± 7.5; range 52-102 years), we estimated the prevalence and burden of several chronic pain phenotypes by age and sex. Overall, 36.0% had chronic multisite pain, 15.6% chronic WSP, and 10.4% bothersome/high-impact chronic pain (B-HICP) as defined by a combination of pain frequency, severity, and interference. The prevalence of extensive (i.e., multisite or WSP) pain and number of pain sites did not increase with age in men or women. However, pain interference was higher for women and the physical component of HRQOL higher for both men and women with advancing age. In summary, while extensive pain classifications were not more prevalent at older ages, pain burden was positively associated with age.

Chronic pain may be an important factor influencing cognitive impairment; however, there is limited research on that link in older adults with disabilities. We aimed to determine the association between chronic pain and cognitive impairment in older adults with disabilities. This 24-month prospective cohort study involved 143 Japanese older adults (≥65 years of age) with long-term care insurance. Chronic pain was defined as pain persisting for ≥3 months, and cognitive impairment was defined as a Mini-Mental State Examination score ≤ 23. We employed logistic regression analysis with chronic pain as the independent variable and cognitive impairment as the dependent variable after propensity score matching (PSM). Sixty-six participants were selected using PSM, and logistic regression analysis showed that chronic pain was significantly associated with cognitive impairment (odds ratio: 4.103, 95% confidence interval: 1.455-11.567, P = 0.008). To prevent cognitive impairment in older adults with disabilities, the management of chronic pain should be considered, as they are related.

Chronic pain is a worldwide health concern in aging populations, often accompanying chronic diseases. Despite its prevalence, the impact of chronic pain in older adults is frequently underestimated. This study examines the prevalence, characteristics, and impact of chronic pain among older adults with chronic diseases. Cross-sectional data from 160 participants aged over 60 years with chronic diseases were collected, including their sociodemographic details, current pain status, and pain management. Data was analyzed using Fisher's exact tests, Student's t-test and multivariable linear regression to examine the relationships between pain interference and multiple variables. The prevalence of current chronic pain was 63.75%, with 69.61% experiencing nociceptive pain. Half of the participants had not received assessment and diagnosis of the chronic pain from health care professionals. Significant associations were observed between perceived pain interference and age (Coefficient = 0.42; 95% CI: 0.07-0.76; p 0.017), maximum pain severity (Coefficient = 1.81; 95% CI: 0.86-2.76; p < 0.001), and pain frequency (Coefficient = 0.22; 95% CI: 0.04-0.39; p 0.015). Common pain management approaches included consultation of healthcare practitioners (40.20%) and alternative medicine (33.33%), with participants reporting high pain interference being more likely to seek practitioner care (58.33%) compared to those with low interference (24.07%, p = 0.001). The high prevalence of chronic pain and pain underestimation in older adults underscores the necessity for comprehensive pain management strategies adopting a patient-centered medicine approach. The provision of education to both physicians and patients on appropriate chronic pain management strategies and options may benefit older adults with chronic diseases.