Abstract
Chronic pain remains a serious healthcare challenge, particularly for older adults
who suffer substantial disability and are susceptible to serious risks from pain medications
and invasive procedures. Psychotherapy is a promising option for older adults with
chronic pain, since it does not contribute to medical or surgical risks. However,
standard psychotherapies for chronic pain, including cognitive-behavioral therapy
(CBT), acceptance and commitment therapy, and mindfulness-based interventions, produce
only modest and time-limited benefits for older adults. In this article, we describe
a novel, evidence-based psychological assessment and treatment approach for older
adults with chronic pain, including a detailed case example. The approach begins with
reviewing patients’ pain, psychosocial, and medical histories to elicit evidence of
a subtype of chronic pain called centralized (primary, nociplastic, or psychophysiologic)
pain, which is highly influenced and may even be caused by life stress, emotions,
and alterations in brain function. Patients then undertake a novel psychotherapy approach
called emotional awareness and expression therapy (EAET) that aims to reduce or eliminate
centralized pain by resolving trauma and emotional conflicts and learning healthy
communication of adaptive emotions. Our published preliminary clinical trial (n = 53)
indicated that EAET produced statistically significant and large effect size advantages
over CBT in pain reduction and marginally greater improvements in pain interference
than CBT for older adults with chronic musculoskeletal pain. Geriatric mental healthcare
providers may learn this assessment and treatment approach to benefit many of their
patients with chronic pain.
Key Words
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Article info
Publication history
Published online: July 29, 2022
Accepted:
July 26,
2022
Received in revised form:
July 22,
2022
Received:
March 1,
2022
Identification
Copyright
Published by Elsevier Inc. on behalf of American Association for Geriatric Psychiatry.
