Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Jun 1;64(6):gnae010.
doi: 10.1093/geront/gnae010.

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

Dara Kiu Yi Leung  1 , Annabelle Pui Chi Fong  1 , Frankie Ho Chun Wong  1   2 , Tianyin Liu  1   3 , Gloria Hoi Yan Wong  1 , Terry Yat Sang Lum  1   4
Affiliations
Meta-Analysis

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

Dara Kiu Yi Leung et al. Gerontologist. .

Abstract

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

Research design and methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO number CRD42020222767), a systematic search was undertaken using MEDLINE, Embase, and PsycINFO up to March 21, 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.

Results: Twenty-five trials (N = 2,394 participants) were identified. Six types of nonpharmacological interventions were compared with control conditions (sham/attention control and treatment as usual). Nonpharmacological interventions were associated with significant reductions in pain intensity, pain interference, depressive symptoms, catastrophizing beliefs, and improvement in physical performance (standardized mean differences -0.34 to 0.54). Subgroup analyses based on different nonpharmacological approaches revealed the benefits of psychological approaches combined with physical activity.

Discussion and implications: Nonpharmacological 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: Acupuncture; Biopsychosocial; Exercise; Pain management; Psychological.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram.
See this image and copyright information in PMC

References

    1. Abdulla, A., Adams, N., Bone, M., Elliott, A. M., Gaffin, J., Jones, D., Knaggs, R., Martin, D., Sampson, L., Schofield, P., & British Geriatric Society. (2013). Guidance on the management of pain in older people. Age and Ageing, 42(Suppl. 1), i1–i57. 10.1093/ageing/afs200 - DOI - PubMed
    1. Alonso-Fernández, M., López-López, A., Losada, A., González, J. L., & Wetherell, J. L. (2016). Acceptance and commitment therapy and selective optimization with compensation for institutionalized older people with chronic pain. Pain Medicine (Malden, Mass.), 17(2), 264–277. 10.1111/pme.12885 - DOI - PubMed
    1. American College of Sports Medicine, Riebe, D., Ehrman, J. K., Liguori, G., & Magal, M. (2018). ACSM’s guidelines for exercise testing and prescription (10th ed.). Wolters Kluwer. - PubMed
    1. American Geriatrics Society Panel on Pharmacological Management of Persistent Pain in Older People. (2009). Pharmacological management of persistent pain in older persons. Journal of the American Geriatrics Society, 57(8), 1331–1346. 10.1111/j.1532-5415.2009.02376.x - DOI - PubMed
    1. Andersson, G., Johansson, C., Nordlander, A., & Asmundson, G. J. G. (2012). Chronic pain in older adults: A controlled pilot trial of a brief cognitive-behavioural group treatment. Behavioural and Cognitive Psychotherapy, 40(2), 239–244. 10.1017/s1352465811000646 - DOI - PubMed

Publication types