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The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
Apr, 2025;33 (4): 345-357.

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

Dimitris N Kiosses, Lisa D Ravdin, Samprit Banerjee, Yiyuan Wu, Charles R Henderson, Joanna Pantelides, Emily Petti, Julianna Maisano, Lauren Meador, Patricia Kim, Danielle Vaamonde, M Carrington Reid
Author Information
  1. Dimitris N Kiosses: Weill-Cornell Institute of Geriatric Psychiatry (DNK, JP), Weill Cornell Medicine, White Plains, NY, USA. Electronic address: dkiosses@med.cornell.edu.
  2. Lisa D Ravdin: Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
  3. Samprit Banerjee: Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
  4. Yiyuan Wu: Division of Biostatistics and Epidemiology (YW), Weill Cornell Medicine, New York, NY, USA.
  5. Charles R Henderson: College of Human Ecology (CRH), Cornell University, Ithaca, NY, USA.
  6. Joanna Pantelides: Weill-Cornell Institute of Geriatric Psychiatry (DNK, JP), Weill Cornell Medicine, White Plains, NY, USA.
  7. Emily Petti: Department of Psychological Science (EP), University of California, Irvine, CA, USA.
  8. Julianna Maisano: Department of Pediatrics (JM), Yale University School of Medicine, New Haven, CT, USA.
  9. Lauren Meador: GREGor Stanford Site (LM), Stanford University School of Medicine, Palo Alto, CA, USA.
  10. Patricia Kim: Division of Geriatrics and Palliative Medicine (PK), Weill Cornell Medicine, New York, NY, USA.
  11. Danielle Vaamonde: Touro College of Osteopathic Medicine (DV), New York, NY, USA.
  12. M Carrington Reid: Division of Geriatrics and Palliative Medicine (PK), Weill Cornell Medicine, New York, NY, USA.
PMID: 39875212 DOI: 10.1016/j.jagp.2024.12.008

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.

Keywords

Chronic Pain Cognitive Impairment Depression Older Adults Primary Care Psychosocial Intervention Psychotherapy

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Grants

  1. UL1 TR002384/NCATS NIH HHS
  2. R01 AG070055/NIA NIH HHS
  3. R01 AG050514/NIA NIH HHS
  4. P50 MH113838/NIMH NIH HHS
  5. K24 AG053462/NIA NIH HHS
  6. P30 AG022845/NIA NIH HHS

MeSH Term

Humans
Female
Aged
Chronic Pain
Male
Primary Health Care
Depression
Emotional Regulation
Aged, 80 and over
Pain Management
Psychosocial Intervention
Emotions
Pain Measurement
Journal Article Randomized Controlled Trial

Word Cloud

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