Assessing the Effectiveness of Non-Pharmacologic Interventions for Older Patients Experiencing Chronic Pain

Abstract

Purpose: To review the literature regarding the effectiveness of opioids and non-pharmacologic interventions in alleviating chronic pain and to examine the effectiveness of a pilot program at a community health center that used a multimodal, non-pharmacologic strategy to manage pain experienced by low-income adults over the age of 50. Methods: A review of the literature was conducted in February 2016 using the PubMed database. From September 2012 until May 2013, the Benson Henry Institute’s Wellness Center at MGH Revere HealthCare Center offered the Moving With Ease program, which provided low-cost, non-pharmacologic treatments for chronic pain, including massage, acupuncture, yoga, and relaxation training, to 25 low-income patients over the age of 50. Primary outcomes were self-reported pain, depression score, and self-perceived stress, as measured by the Brief Pain Inventory (BPI), the Patient Health Questionnaire (PHQ-2), and the Perceived Stress Scale (PSS). Differences between pre- and post-program scores were analyzed using paired t-tests with p<0.05. In addition, semi-structured interviews were conducted to further understand participants’ experiences. Results: The literature review found that there is insufficient evidence to evaluate the long-term efficacy of opioid and integrative treatments for chronic pain, especially in older adults, and that there are significant harms associated with opioid-based treatments. Pilot study data was collected from all 25 patients; 10 patients were interviewed about their experiences with the Moving With Ease program. Participant ages ranged from 52 to 88 years, with a mean age of 70 years; 16 of the 25 participants were women. Improvements were observed in some scores but there were not statistically significant improvements between participants’ pre- and post-program scores on the BPI, PHQ-2, or PSS. The analysis of the qualitative data suggests that patients’ perceived benefits from participating in the program are notable, and in several cases, life-changing. Conclusions: There remains uncertainty about the efficacy of treatments for chronic pain and how to tailor them to individual patients. The quantitative results of the pilot study suggest that the intervention was effective in reducing pain, however the findings were non-significant. Participants’ qualitative descriptions of the benefits of the program further indicate that a multimodal integrative approach may be effective for older patients experiencing chronic pain. Limitations of the approach include its small sample size and possible response bias, since not all participants were available to be interviewed.