Kiosses Dimitris N, Ravdin Lisa D, Stern Amy, Bolier Ruth, Kenien Cara, Reid M Carrington
Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY 10605, USA.
Weill Cornell Medicine, 428 East 72nd Street, Suite 500, New York, NY 10021, USA.
Geriatrics (Basel). 2017;2(1). doi: 10.3390/geriatrics2010005. Epub 2017 Jan 16.
Chronic pain is highly prevalent in older adults, contributes to activity restriction and social isolation, disrupts family and interpersonal relationships, and poses a significant economic burden to society. Negative emotions such as sadness, anxiety, helplessness, and hopelessness are associated with chronic pain and contribute to poor quality of life, impaired interpersonal and social functioning, and increased disability. Psychosocial interventions for older adults with chronic pain have been historically developed for, and are almost exclusively delivered to, cognitively intact patients. Therefore, many older adults with chronic pain and comorbid cognitive deficits have limited treatment options. Our multidisciplinary team developed Problem Adaptation Therapy for Pain in Primary Care (PATH-Pain), a psychosocial intervention for older adults with chronic pain, negative emotions, and a wide range of cognitive functioning, including mild-to-moderate cognitive impairment. In the current article, we describe the principles underlying PATH-Pain, review the steps taken to adapt the original PATH protocol, outline the treatment process, and present a case illustrating its potential value.
慢性疼痛在老年人中非常普遍，会导致活动受限和社会隔离，破坏家庭和人际关系，并给社会带来重大经济负担。悲伤、焦虑、无助和绝望等负面情绪与慢性疼痛相关，会导致生活质量下降、人际和社会功能受损以及残疾增加。针对患有慢性疼痛的老年人的心理社会干预措施，历来是为认知健全的患者开发的，而且几乎完全是针对这类患者实施的。因此，许多患有慢性疼痛和合并认知缺陷的老年人治疗选择有限。我们的多学科团队开发了初级保健疼痛问题适应疗法（PATH-Pain），这是一种针对患有慢性疼痛、负面情绪以及包括轻度至中度认知障碍在内的广泛认知功能的老年人的心理社会干预措施。在本文中，我们描述了PATH-Pain的基本原则，回顾了调整原始PATH方案所采取的步骤，概述了治疗过程，并展示了一个案例来说明其潜在价值。
