@article{913c18e13e12421ebbafee1c6dbde51a,
title = "Clin-STAR corner: 2021 update in musculoskeletal pain in older adults with a focus on osteoarthritis-related pain",
abstract = "Chronic musculoskeletal (MSK) pain remains a leading cause of disability and functional impairment among older adults and is associated with substantial societal and personal costs. Chronic pain is particularly challenging to manage in older adults because of multimorbidity, concerns about treatment-related harm, as well as older adults' beliefs about pain and its management. This narrative review presents data on nine high-quality, peer-reviewed clinical trials published primarily over the past two years that focus on MSK pain management in older adults, of which four were comprehensively reviewed. These studies address contributors to knee osteoarthritis (OA) pain (insomnia), provide evidence for digital delivery or artificial intelligence driven behavioral interventions and potentially more efficient/equally effective modes of delivering glucocorticoids for OA; each of the selected studies have potential for scalability and meaningful impact in the care of older adults.",
keywords = "aging, back pain, behavioral approaches, comorbidity, musculoskeletal pain, osteoarthritis",
author = "Owoicho Adogwa and Reid, {M. Cary} and Sai Chilakapati and Makris, {Una E.}",
note = "Funding Information: Owoicho Adogwa is supported by (Clin‐STAR pilot grant—U24AG065204). M. Cary Reid is supported by (NIA [P30 AG022845, K24 AG053462, R01 AG070055], and NIDDK [R01 DK131050]). Una E. Makris is supported in part by a grant from VA HSR&D (IIR 20‐256). Funding Information: Owoicho Adogwa is supported by (Clin-STAR pilot grant—U24AG065204). M. Cary Reid is supported by (NIA [P30 AG022845, K24 AG053462, R01 AG070055], and NIDDK [R01 DK131050]). Una E. Makris is supported in part by a grant from VA HSR&D (IIR 20-256). These data suggest that telephone-based CBT-I is effective in improving sleep and pain among older adults with comorbid insomnia and OA. Integrating behavioral health services (including CBT) into primary care practices (where most older adults receive pain care) may be a useful strategy for improving outcomes in older adults with insomnia and OA. The study addresses several important knowledge gaps. First, it represents one of the largest studies conducted on this topic to date. Second, the 12-month follow-up results established treatment durability. Importantly, an ISI score of <7 indicates insomnia remission and this outcome was sustained over 12 months. Some limitations included: participants were predominantly White older adults and recruited from a single health system, limiting the generalizability of the study findings. Although research staff obtaining patient-reported outcomes were blinded, interventionists were not blinded to group allocation. Insomnia and other sleep disturbances are common among older adults and often comorbid with OA. This RCT tested the effectiveness of CBT for insomnia (CBT-I) delivered via telephone versus an education-only control group (EOC) in older adults with moderate-to-severe OA pain. The intervention consisted of six 20-to-30 min telephone-based sessions delivered by trained coaches which included an MS-level psychologist, a PhD nurse, and a PhD social worker over 8 weeks. CBT-I participants received instructions on sleep restriction, stimulus control, sleep hygiene, homework, and cognitive restructuring using techniques to address negative thoughts that contribute to insomnia. EOC participants received general information about sleep and OA. The primary outcome measure was the Insomnia Severity Index (ISI) score at 2- and 12-months posttreatment. A total of 327 participants (mean age [SD] 70.2 [6.8 years]) were randomized to CBT-I or EOC. At 2 months posttreatment, the ISI score decreased 8.1 points in the CBT-I group compared to 4.8 points in the EOC group. Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals LLC on behalf of The American Geriatrics Society.",
year = "2023",
doi = "10.1111/jgs.18369",
language = "English (US)",
journal = "Journal of the American Geriatrics Society",
issn = "0002-8614",
publisher = "Wiley-Blackwell",
}