Problem Adaptation Therapy for Older Adults with Chronic Pain and Negative Emotions in Primary Care (PATH-Pain): A Randomized Clinical Trial

IF 3.8 2区医学 Q1 GERIATRICS & GERONTOLOGY American Journal of Geriatric Psychiatry Pub Date : 2025-01-06 DOI:10.1016/j.jagp.2024.12.008

Dimitris N. Kiosses Ph.D. , Lisa D. Ravdin Ph.D. , Samprit Banerjee Ph.D., M.Stat. , Yiyuan Wu M.S. , Charles R. Henderson Jr. M.A. , Joanna Pantelides M.A. , Emily Petti M.A. , Julianna Maisano B.S. , Lauren Meador M.P.H. , Patricia Kim M.S.W. , Danielle Vaamonde B.A , M. Carrington Reid M.D., Ph.D.

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Abstract

Objective

To test the efficacy of Problem Adaptation Therapy for Pain (PATH-Pain) versus Usual Care (UC) in reducing pain-related disability, pain intensity, and depression among older adults with chronic pain and negative emotions.

Design

RCT assessing the between-group differences during the acute (0–10 weeks) and follow-up (weeks 11–24) phase of treatment.

Setting

A geriatrics primary care site.

Participants

100 participants (80 % females, Mean Age = 75.5) with chronic pain, negative emotions, and varying cognition (56 % had cognitive impairment) were randomly assigned to PATH-Pain (N = 49) or UC (N = 51).

Interventions

PATH-Pain is a collaborative program which includes a psychosocial intervention designed to improve emotion regulation. UC participants received a booklet that described evidence-based self-management pain strategies.

Measurements

Primary outcomes: Pain-related disability (Modified Roland-Morris Disability Questionnaire), and pain intensity. Secondary outcomes: Depression (Montgomery-Asberg Depression Rating Scale), emotion regulation (Emotion Regulation Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire).

Results

During acute treatment (by Week 10), PATH-Pain vs. UC participants showed a significant decrease in pain-related disability [contrast mean difference (CMD) = −1.96, P = 0.02), CI [−0.47, −3.44]] and in depression severity (CMD = −2.50, P = 0.03, CI [−.0.23, −4.76]), but not in pain intensity. PATH-Pain (vs. UC) participants also demonstrated a significant improvement in expressive suppression, an aspect of emotion regulation (CMD = 2.120, P = 0.010, CI [.085, 4.155]). During follow-up (Week 11 to 24), there were no significant between-group differences in pain-related disability, pain intensity, or depression severity.

Conclusions

This primarycarebased study demonstrates the short-term efficacy of PATH-Pain versus UC in reducing pain-related disability and depression in older adults with comorbid chronic pain and negative emotions, as well as varying degrees of cognitive functioning.

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初级保健中老年人慢性疼痛和负面情绪的问题适应疗法（PATH-Pain）：一项随机临床试验。

目的：比较疼痛问题适应疗法（PATH-Pain）与常规护理（UC）在减轻老年人慢性疼痛和负面情绪的疼痛相关残疾、疼痛强度和抑郁方面的疗效。设计：RCT评估急性（0-10周）和随访（11-24周）治疗期组间差异。环境：一个老年初级保健站点。参与者：100名慢性疼痛、负面情绪和不同认知（56%有认知障碍）的参与者（80%为女性，平均年龄= 75.5）被随机分配到PATH-Pain （N = 49）或UC （N = 51）组。干预：PATH-Pain是一个协作项目，包括旨在改善情绪调节的心理社会干预。UC参与者收到一本小册子，描述了基于证据的自我管理疼痛策略。测量：主要结果：疼痛相关残疾（改良罗兰-莫里斯残疾问卷）和疼痛强度。次要结局：抑郁（Montgomery-Asberg抑郁评定量表）、情绪调节（情绪调节问卷）和治疗满意度（来访者满意度问卷）。结果：在急性治疗期间（到第10周），PATH-Pain与UC参与者在疼痛相关功能障碍（对比平均差值(CMD) = -1.96, P = 0.02）， CI[-0.47, -3.44])和抑郁严重程度（CMD = -2.50, P = 0.03, CI[- 0.23, -4.76]）方面显着降低，但在疼痛强度方面没有显著降低。PATH-Pain（与UC相比）参与者在表达抑制方面也表现出显著改善，表达抑制是情绪调节的一个方面（CMD = 2.120, P = 0.010， CI）。085年,4.155])。在随访期间（第11周至第24周），两组在疼痛相关残疾、疼痛强度或抑郁严重程度方面无显著差异。结论：这项以初级保健为基础的研究证明了PATH-Pain与UC在减少伴随慢性疼痛和负面情绪以及不同程度认知功能的老年人疼痛相关残疾和抑郁方面的短期疗效。

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来源期刊

American Journal of Geriatric Psychiatry 医学-精神病学

CiteScore

13.00

自引率

4.20%

发文量

381

审稿时长

26 days

期刊介绍： The American Journal of Geriatric Psychiatry is the leading source of information in the rapidly evolving field of geriatric psychiatry. This esteemed journal features peer-reviewed articles covering topics such as the diagnosis and classification of psychiatric disorders in older adults, epidemiological and biological correlates of mental health in the elderly, and psychopharmacology and other somatic treatments. Published twelve times a year, the journal serves as an authoritative resource for professionals in the field.