Chronic pain self-management for older adults with cognitive impairment: A randomized pilot trial

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Project Summary Psychosocial interventions for chronic pain are largely untested in the growing segment of the older population living with mild cognitive impairment or early-stage Alzheimer’s disease and related dementias (MCI/ADRD). Chronic pain and cognitive impairment each exacerbate symptoms of the other, accelerating functional decline. While cognitive-behavioral strategies can improve pain-related functioning, standard interventions teaching these skills may not be effective in older adults with cognitive deficits. This proposed supplement will augment the work of the parent study, a randomized controlled trial of the STEPS chronic pain self-management intervention for underserved older adults, by modifying the intervention to be suitable for people living with MCI/ADRD. The original STEPS, delivered through telephone sessions with a community health worker, is already designed to address challenges common in low-income urban communities such as low health literacy, resource needs, and lack of transportation. The new version, called STEPS-CI, will offer simplified chronic pain education and modified processes for skill-building, and will connect participants to resources for MCI/ADRD and caregiving. Preparatory work for this supplement included: 1) interviews with experts about the pain management capabilities and needs of people with MCI/ADRD; and 2) focus groups with people living with chronic pain and MCI/ADRD. Findings confirmed the need for improved pain management skills in this population and yielded information about how STEPS could be tailored. The aims of this supplement are as follows: 1) Based on preliminary findings and in consultation with the newly formed STEPS-CI Advisory Council, modify the existing STEPS curriculum and program materials; and 2) Conduct a NIH Behavioral Intervention Stage 1 randomized pilot trial with 50 older adults (with optional care partners) who report chronic musculoskeletal pain and mild to moderate cognitive impairment, and assess its acceptability and preliminary effects on primary (pain interference) and secondary (pain intensity and subjective cognitive function) outcomes. Impact on pain medication use will be an exploratory outcome. Mixed methods will be used to evaluate key program processes including participant engagement, and to shed light on reasons for observed outcomes. Pilot study participants will be recruited from the same urban community as the parent trial (Detroit, MI), leveraging existing mechanisms; and, as an exploratory element, a subset of rural participants in northern Michigan will also be recruited, given the similarities in access barriers across these two underserved populations. The National Council of Dementia Minds, an advocacy and support organization led by people living with dementia, will advise on all study phases and processes through the STEPS-CI Advisory Council. This pilot study set the stage for a subsequent Stage 2 or 3 trial, if STEPS-CI is shown to be feasible and demonstrates potential efficacy; otherwise, it will provide valuable information leading to the development of alternative ways to meet the chronic pain management needs of older adults living with MCI/ADRD.