Mindfulness-Based Group Therapy for Geriatric Chronic Pain Management

Chronic pain management is a common challenge in geriatric patients, affecting up to half of older adults living in the community and about 80% of nursing home residents.¹

Poor pain control results in adverse outcomes, including depression, anxiety, sleep problems, increased use of healthcare, and increased costs. Chronic opioid therapy has limited efficacy, as anecdotal evidence suggests.² Older adults are also at higher risk than younger ones for adverse reactions from opioid therapy.³

Nonpharmacological approaches that work are sorely needed. One route to such long-term relief, evolving research suggests, is mindfulness meditation. As an approach, mindfulness practice has long been recommended for stress relief and other mental health conditions. Experts also believe it can help chronic pain.

What has been lacking, however, is enough evidence in older adults.

Now, in a recent report, researchers from the University of Michigan tested a mindfulness-based group therapy program tailored to help older adults cope with chronic pain. The study was small, but included a control group and results for the intervention were impressive.¹

The key to the success for participants in this program? “Your relationship with pain has changed,” explained Mariko Foulk, LMSW, ACSW, a clinical social worker at Michigan Medicine, Ann Arbor, who conducted the study with three colleagues. “Instead of pain as your enemy, you develop a friendlier relationship with your enemy, so to speak.”

Mindfulness-based stress reduction (MBSR) has gained attention in recent years in the medical literature as a valid approach to pain management, beginning with the work of pioneer Jon Kabat-Zinn, PhD, who developed mindfulness-based stress reduction groups and offered them in a hospital outpatient setting to those who had severe chronic pain.^1,4

The Foulk et al study is one of the few to focus on older adults, providing much-needed data on this population group. Their pilot work at the University of Michigan’s senior community center provides a blueprint for others hoping to set up similar pain management programs.

Foulk and her team recruited community-dwelling older adults with chronic pain who were receiving medical care. To be eligible, participants had to be age 60 or older, willing to participate in at least 7 of 8 sessions, each 2.5 hours long, do homework practice, and complete pre- and post-program surveys.

The intervention group enrolled 19 and the control group had 18, with 13 remaining for analysis in the intervention group and 11 in the control group. All were women, a limitation to the research the investigators acknowledged. The mean ages were similar: 72.8 years for the intervention group and 77 for the control group.¹

The sessions covered a wide range of topics: mindfulness of breath meditation, gentle mindful movement, acceptance and self-compassion, noticing pleasant elements in daily life, and awareness of self-care. Participants kept a diary to report on their mindfulness of daily activity and pacing themselves, learned the body scan meditation practice, and the importance of connection over isolation, among other lessons.

Foulk’s team found significant differences between the groups. The intervention group had more acceptance of the pain, more of what Foulk called “pain willingness.” That means people’s thinking about pain changed, she explained. Before the program, people’s view of the pain was “I have to fix it, no matter what.” After the program, they focused on living their life, despite the chronic pain.¹

Foulk et al found statistically significant improvements in three areas: increased activity levels, increased pain willingness, and decreased generalized anxiety symptoms. The intervention group’s scores rose significantly in the activity acceptance and pain willingness scores, while the control group’s scores remained the same or decreased. The intervention group’s anxiety scores improved, but the control group’s were static.

Although the study did not measure the use of medications pre-and post-program, participants self-reported their medication use. One participant was able to cut back on oxycodone and finally give it up at the end of the program. Others reported they did not need as much pain medication by the end of the sessions.

Foulk’s take: “Your interpretation of the pain gets less, and all of that affects your experience of pain. Pain is not just physical pain.” Slowly, as the program proceeded, participants began to think that even with pain, they could live their life, Foulk said. Their attitude changed, she found, and their activity levels increased. Instead of putting off activity until the pain disappeared, they scheduled that activity and did their best.

Despite the small numbers, Foulk’s study on mindfulness-based group therapy for chronic pain produced ‘’hopeful results,” said Hassan Majeed, MD, a psychiatrist and interventional pain physician based in Bethesda, MD. Such an approach is especially important and valuable, he said, for older adults.

In reviewing the study results, Dr. Majeed noted that the increasing functionality found among participants, and the willingness to live their lives, was most important. The decrease in anxiety was important, too, he said. In his practice, he said he finds that generalized anxiety is the most common co-existing condition in older adults with chronic pain.

The other benefits of using a non-pharmacological approach, he said, include no side effects from medication and no need for chronic long-term monitoring of medications.

“It’s also a skill they are learning,” he said of mindfulness training. Once it is learned, “they can use it without the doctors or prescribers being present.” And, he added, “they can use it anytime they need it.” It could very well become a lifetime habit, and a frequent avenue to coping better with chronic pain.

Dr. Majeed includes a mindfulness intervention as part of his treatment program in his own practice. His bottom line for treating chronic pain in older adults: “Stay conservative and avoid long-term use of medications.”

For primary care practices, as well as mental health professionals who do not offer MBSR, finding a program can take some effort. While online searching for MBSR programs will produce numerous results, it’s important to research their experience in pain management and their experience with older adults.

If programs are not available in the local community, another avenue is to find university-hosted or institute-hosted programs, such as the University of California San Diego or the Copper Beech Institute, which offers online courses, but also to ask if the focus is on chronic pain.⁵

Integrating mental health services into primary care is also a growing approach.