Abstract
Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability. Psychosocial interventions for older adults with chronic pain have been historically developed for, and are almost exclusively delivered to, cognitively intact patients. Therefore, many older adults with chronic pain and comorbid cognitive deficits have limited treatment options. Our multidisciplinary team developed Problem Adaptation Therapy for Pain in Primary Care (PATH-Pain), a psychosocial intervention for older adults with chronic pain, negative emotions, and a wide range of cognitive functioning, including mild-to-moderate cognitive impairment. In the current article, we describe the principles underlying PATH-Pain, review the steps taken to adapt the original PATH protocol, outline the treatment process, and present a case illustrating its potential value.
Highlights
Chronic pain is highly prevalent in older adults and associated with emotional disturbances, activity restriction, social isolation, falls, and sleep impairment [1]
PATH-Pain to (a) (e.g., reduce negative emotionsanger, (e.g., hopelessness, sadness, irritability, anger, aims to (a) reduce negativeaims emotions sadness, irritability, helplessness, hopelessness, guilt, anxiety); (b)(e.g., promote positive emotions; (c) break guilt, anxiety);helplessness, (b) promote positive emotions pleasure); (c) break the vicious cycle of inactivity the vicious cycle of that is promoted by negative emotions, pain, and physical limitations; that is promoted byinactivity negative emotions, pain, and physical limitations; (d) improve communication (d) improve communication between the patient primarybarriers care physician; and (e) address between the patient and primary care physician; andand (e) address to pain and psychological barriers to(Figure pain and psychological treatment
Following this review and analysis, panel members conducted (1) in-depth clinical interviews with 10 older adults with chronic pain, negative emotions, and a wide range of cognitive functioning to gain insight into the respective roles of negative and positive emotions in the target population; and (2) a pilot study of 102 older adults with chronic pain in primary care to identify the types of problems these patients routinely face, examine the effects of negative and positive emotions on pain and pain-related disability, and assess the vicious cycle of inactivity by describing the pleasurable activities older adults typically pursue and the extent to which these activities are modified because of pain (PI: Reid) [19]
Summary
Chronic pain is highly prevalent in older adults and associated with emotional disturbances, activity restriction, social isolation, falls, and sleep impairment [1]. Negative emotions, including sadness, anxiety, helplessness, and hopelessness, are associated with chronic pain [5,6,7] and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability [5,6,8]. A psychosocial intervention focusing on reducing negative emotionsnegative and increasing positive emotions positive emotions may reduce pain intensity and pain-related disability. To the best of our knowledge, knowledge, nointervention behavioral intervention has been developed specificallytodeveloped to address in older no behavioral has been address pain in olderpain adults with adults with co-occurring cognitive impairment and negative emotions. PATH seeks to reduce depression and improve functioning improve functioning in older adults with comorbid depression and cognitive impairment. Value of the intervention, and highlight potential challenges to its implementation
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