Background & Aims
A 2017 NHS report found that 47% of men and 52% of women aged over 65 suffer with chronic pain, with the prevalence of chronic pain positively correlating with older age (NHS digital, 2018). It has also been suggested that pain can be difficult to manage in older adults (Schofield, 2007). Older people are more likely to experience events such as bereavement and a drop in socioeconomic status with retirement. All of these stressors can result in isolation, loneliness or psychological distress, known factors that can worsen chronic pain symptoms (Scherder et al 2005). Our service identified the need for a Specialist Older Adult Pain Management Programme (PMP), known as Oasis, to increase inclusivity, engagement and peer support for older patients whilst adapting content for age-related themes.
Aims: To determine the efficacy of a newly developed specialised pain management programme tailored to the needs of older adults.
Methods
A total of 41 patients were assessed between June 2021 and October 2023 by the multidisciplinary team (MDT) were deemed suitable for Oasis. Of which, 26 patients (female:male=18:8) with an average age of 73 years (4.4 SD) and an average pain duration of 137 months attended Oasis. A total of 19 completed the PMP with 5 attending their 6 month follow up. Outcomes were collected at pre-treatment, post-treatment and at 6-month follow-up. Self-reported outcomes comprised pain intensity and distress, pain catastrophising, depression, pain-self-efficacy, acceptance, physical functioning, and occupational therapy (OT) goal measures. For physical functioning outcomes, the Sit to Stand (STS) and 5 Minute Walk tests were conducted. Anonymised patient feedback was collected at reassessment and follow-up, as well as a patient satisfaction surveys and telephone feedback for the first two groups; adjustments were made to the content based on this.
Results
Those with complete data sets (n=19) were analysed using paired sample t-tests and effect of treatment sizes presented (ES). Significant improvements post-PMP were reported for pain catastrophising (ES=0.73), self-efficacy (ES=1.41), depression (ES=0.75), pain acceptance (ES=0.73), fear of movement (ES=0.76) and goal progress (ES=2.11). Improvements in physical functioning showed a non-significant trend. The patient satisfaction survey showed 95% of patients were likely or extremely likely to recommend the programme. Patient feedback showed a preference for physiotherapy led aspects of the programme. Areas for improvement suggested by patients included more input for family and friends and to include a longer break between sessions. All but one patient felt that a specialist older adult PMP was necessary for their specific needs.
Conclusions
The outcomes suggest that a multidisciplinary rehabilitation programme delivered specifically for older adults with chronic pain is an effective intervention. Attendance on the PMP has led to improvements in psychological and physical functioning. Patient feedback also indicates that most patients feel that a specialist older adult PMP was necessary for their specific needs. Further research is required on larger samples with follow up data.
References
NHS Digital. (2018). Health Survey for England 2017: Adult Health. https://healthsurvey.hscic.gov.uk/media/78628/HSE17-Adult-Health-rep.pdf
Scherder, E., Oosterman, J., Swaab, D. (2005) Recent developments in pain in dementia. British Medical Journal, 461–464
Schofield, P. (2007). Pain in Older Adults: Epidemiology, Impact and Barriers to Management. Review of Pain, 1(1), 12-14.
Presenting Author
Alexandra Waddington
Poster Authors
Alexandra Waddington
DClinPsy
The Walton Centre NHS FT
Lead Author
Alison Bradshaw (BSc Hons)
The Walton Centre NHS Trust
Lead Author
Jacqueline Fitzlynam
BSc
The Walton Centre NHS Foundation Trust
Lead Author
Matt Liptrott (MSc)
The Walton Centre NHS Trust
Lead Author
Katie Herron DClinPsych
PhD
Walton Centre NHS Foundation Trust, Liverpool
Lead Author
Topics
- Pain in Special Populations: Elderly