The effects of guided imagery on affect, cognition, and pain in older adults in residential care: a randomized controlled study from Thailand

Management of Chronic Pain in Long-Term Care: A Systematic Review and Meta-Analysis

OBJECTIVES

Pain, a complex subjective experience, is common in care home residents. Despite advances in pain management, optimal pain control remains a challenge. In this updated systematic review, we examined effectiveness of interventions for treating chronic pain in care home residents.

DESIGN

A Cochrane-style systematic review and meta-analysis using PRISMA guidelines.

SETTING AND PARTICIPANTS

Randomized and nonrandomized controlled trials and intervention studies included care home residents aged ≥60 years receiving interventions to reduce chronic pain.

METHODS

Six databases were searched to identify relevant studies. After duplicate removal, articles were screened by title and abstract. Full-text articles were reviewed and included if they implemented a pain management intervention and measured pain with a standardized quantitative pain scale. Meta-analyses calculated standardized mean differences (SMDs) using random-effect models. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool 2.0.

RESULTS

We included 42 trials in the meta-analysis and described 13 more studies narratively. Studies included 26 nondrug alternative treatments, 8 education interventions, 7 system modifications, 3 nonanalgesic drug treatments, 2 analgesic treatments, and 9 combined interventions. Pooled results at trial completion revealed that, except for nonanalgesic drugs and health system modification interventions, all interventions were at least moderately effective in reducing pain. Analgesic treatments (SMD -0.80; 95% CI -1.47 to -0.12; P = .02) showed the greatest treatment effect, followed by nondrug alternative treatments (SMD -0.70; 95% CI -0.95 to -0.45; P < .001), combined interventions (SMD -0.37; 95% CI -0.60 to -0.13; P = .002), and education interventions (SMD -0.31; 95% CI -0.48 to -0.15; P < .001).

CONCLUSIONS AND IMPLICATIONS

Our findings suggest that analgesic drugs and nondrug alternative pain management strategies are the most effective in reducing pain among care home residents. Clinicians should also consider implementing nondrug alternative therapies in care homes, rather than relying solely on analgesic drug options.

Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial

BACKGROUND

Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI.

OBJECTIVES

The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI.

METHODS

A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks.

RESULTS

There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (-2.1 [CI -2.78 to -1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (-4.52 [CI -5.86 to -3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly (P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients' Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change.

CONCLUSIONS

This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry-India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.

Mental imagery training for treatment of central neuropathic pain: a narrative review

Mental imagery is a quasi-perceptual experience in the absence of external stimuli. This concept has intrigued psychologists, sportspersons, neurologists and other scientists for over a decade now. Imagery has been used in rehabilitation and the results have been promising. Researchers refer to this as healing the body through the mind. However, the challenge is lack of standardized protocols, homogeneity and consistency in application of mental imagery in different populations. The purpose of this review is to discuss and understand the role of mental imagery in the treatment of central neuropathic pain (CNP). Treatment options of CNP are inadequate and their benefits are short lived. We conducted an extensive search on various databases using combinations of different keywords and reviewed the available literature in this area. We were able to finalize twelve studies where mental imagery was used for treating CNP in spinal cord injury (SCI), stroke and multiple sclerosis. However, the methodology and techniques of mental imagery training used in these studies were non-homogeneous and inconsistent. This review provides a guiding framework to further explore the different techniques of mental imagery and their roles in treating CNP.

Psychological Treatments for Chronic Pain in East and Southeast Asia: A Systematic Review

BACKGROUND

Psychological treatments are recognised as generally effective for chronic pain. However, little is known about the evidence for psychological treatments for chronic pain in Asia.

PURPOSE

This study aimed (1) to identify all treatment outcome studies in the area of psychological approaches to chronic pain in adult populations of East Asia and Southeast Asia and (2) to evaluate the treatment types, the evidence for treatment outcomes and research design quality with regard to these studies.

METHODS

We identified all psychologically based treatment outcome studies for chronic pain in East and Southeast Asia by searching CENTRAL, EMBASE, PsycINFO, MEDLINE (via Ovid), Global Health and Web of Science from the beginning of each abstracting service until December 2014 (week 4).

RESULTS

Seventeen studies met inclusion criteria including a total of N = 1,890 participants. Four were randomised controlled trials (RCTs), five controlled clinical trials (CCTs) and eight cohort studies. Treatment outcomes included pain, disability, depression and anxiety. Overall, the studies included in this review showed small to medium within-group effect sizes for all four outcomes. A majority of the studies were rated as weak in design quality. Three RCTs were found to be of strong quality, one of moderate quality and only one CCT of moderate quality.

CONCLUSION

The current available literature on psychological treatments for chronic pain in East and Southeast Asia is generally small in scale, mostly preliminary and lags behind on some developments occurring in North America and Europe. Further development of treatment methods and research designs is warranted.

Treatment of depression in nursing home residents without significant cognitive impairment: a systematic review

BACKGROUND

Depression in nursing facilities is widespread and has been historically under-recognized and inadequately treated. Many interventions have targeted depression among residents with dementia in these settings. Less is known about depression treatment in residents without dementia who may be more likely to return to community living. Our study aimed to systematically evaluate randomized control trials (RCTs) in nursing facilities that targeted depression within samples largely comprised of residents without dementia.

METHODS

The following databases were evaluated with searches covering January 1991 to December 2015 (PubMed, PsycINFO) and March 2016 (CINAHL). We also examined national and international clinical trial registries including ClinicalTrials.gov. RCTs were included if they were published in English, evaluated depression or depressive symptoms as primary or secondary outcomes, and included a sample with a mean age of 65 years and over for which most had no or only mild cognitive impairment.

RESULTS

A total of 32 RCTs met our criteria including those testing psychotherapeutic interventions (n=13), psychosocial and recreation interventions (n=9), and pharmacologic or other biologic interventions (n=10). Seven psychotherapeutic, six psychosocial and recreation, and four pharmacologic or other biologic interventions demonstrated a treatment benefit.

CONCLUSIONS

Many studies had small samples, were of poor methodological quality, and did not select for depressed residents. There is limited evidence suggesting that cognitive behavioral therapies, reminiscence, interventions to reduce social isolation, and exercise-based interventions have some promise for decreasing depression in cognitively intact nursing home residents; little can be concluded from the pharmacologic or other biologic RCTs.

Mixed Experiences and Perceptions of Psychological Treatment for Chronic Pain in Singapore: Skepticism, Ambivalence, Satisfaction, and Potential

There is little research in Southeast Asia focusing on patients' experiences of seeking psychological treatment for chronic pain.

OBJECTIVE

This study aims to understand the experiences of patients seeking psychological treatment for chronic pain in this region.

SETTING

Outpatient pain clinic at a tertiary hospital in Singapore.

SUBJECTS

People with experiences of attending psychological treatment for chronic pain, including some who were not receiving this type of treatment.

STUDY DESIGN AND METHODS

Fifteen inductive semi-structured interviews were conducted to explore patients' experiences regarding psychological treatment for their chronic pain. Thematic analysis was then applied.

RESULTS

Three main themes were identified: "Expectations and Realities of Health Professionals," "Patients' Attitudes and Beliefs," and "Practical and Social Factors." From the patients' perspectives, an empathetic health professional who was willing to listen contributed to a positive treatment seeking experience. Patients felt that health professionals' lack of knowledge about appropriate treatment contributed to their frustration. Patients could not understand how psychological treatment was related to pain treatment and queried why they were "paying just to talk." Conversely, their experiences were quite positive, and they found psychological treatments helpful when they participated in them.

CONCLUSION

Education for both patients and health professionals unfamiliar with psychological treatments for pain may improve access to these treatments.