Kiosses Dimitris N, Ravdin Lisa D, Banerjee Samprit, Wu Yiyuan, Henderson Charles R, Pantelides Joanna, Petti Emily, Maisano Julianna, Meador Lauren, Kim Patricia, Vaamonde Danielle, Reid M Carrington
Weill-Cornell Institute of Geriatric Psychiatry (DNK, JP), Weill Cornell Medicine, White Plains, NY, USA.
Department of Neurology, Weill Cornell Medicine, New York, NY, USA; Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA.
Am J Geriatr Psychiatry. 2025 Apr;33(4):345-357. doi: 10.1016/j.jagp.2024.12.008. Epub 2025 Jan 6.
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.
RCT assessing the between-group differences during the acute (0-10 weeks) and follow-up (weeks 11-24) phase of treatment.
A geriatrics primary care site.
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).
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.
Primary outcomes: Pain-related disability (Modified Roland-Morris Disability Questionnaire), and pain intensity.
Depression (Montgomery-Asberg Depression Rating Scale), emotion regulation (Emotion Regulation Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire).
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.
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.
测试疼痛问题适应疗法（PATH-Pain）与常规护理（UC）相比，在减少患有慢性疼痛和负面情绪的老年人的疼痛相关残疾、疼痛强度和抑郁方面的疗效。
随机对照试验，评估治疗急性期（0 - 10周）和随访期（11 - 24周）的组间差异。
老年初级保健机构。
100名患有慢性疼痛、负面情绪且认知能力各异（56%有认知障碍）的参与者（80%为女性，平均年龄 = 75.5岁）被随机分配到PATH-Pain组（N = 49）或UC组（N = 51）。
PATH-Pain是一个合作项目，包括旨在改善情绪调节的心理社会干预。UC组参与者收到一本描述基于证据的自我管理疼痛策略的手册。
主要结局：疼痛相关残疾（改良罗兰·莫里斯残疾问卷）和疼痛强度。
抑郁（蒙哥马利 - 阿斯伯格抑郁评定量表）、情绪调节（情绪调节问卷）和治疗满意度（患者满意度问卷）。
在急性治疗期间（到第10周），与UC组相比，PATH-Pain组参与者在疼痛相关残疾方面有显著降低[对比均值差（CMD）= -1.96，P = 0.02，CI [-0.47，-3.44]]，抑郁严重程度也显著降低（CMD = -2.50，P = 0.03，CI [-0.23，-4.76]），但疼痛强度无显著变化。PATH-Pain组（与UC组相比）参与者在情绪调节的一个方面——表达抑制上也有显著改善（CMD = 2.120，P = 0.010，CI [0.085，4.155]）。在随访期间（第11周至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组间差异。
这项基于初级保健的研究表明，与UC相比，PATH-Pain在减少患有慢性疼痛和负面情绪以及不同程度认知功能障碍的老年人的疼痛相关残疾和抑郁方面具有短期疗效。
