Cognitive-Behavioral Pain Management Interventions for Long-Term Care Residents with Physical and Cognitive Disabilities

Fifty to 72% of long-term care (LTC) residents suffer from chronic or intermittent pain that limits activities of daily living (ADL) (Bressler, Keyes, Rochon, & Badley, 1999; Cipher & Clifford, 2004). The efficacy of nonpharmacological treatment for chronic pain management (psychotherapy, biofeedback, relaxation training, hypnosis, physical therapy, exercise, and behavioral interventions) is well established in the clinical psychology literature for both older and younger adults (Cipher, Fernandez, & Clifford, 2001, 2002; Simmons, Ferrell, Schnelle, 2002). Specifically, cognitive-behavioral therapy (CBT) has been an effective modality within an interdisciplinary care team approach focusing on improving the quality of life (QOL) in chronic pain patients (Morley, Eccleston, & Williams, 1999). Sorkin (1990) suggests that older and younger patients with chronic pain are more alike than different in their response to CBT, particularly if the patients are cognitively intact and only suffering from mild levels of physical disability. But when a LTC resident suffers from both cognitive and physical impairments, the assessment and treatment process must be modified considerably (Cipher & Clifford; Cipher, Clifford, & Roper, 2007; Snow et al., 2004). This chapter focuses on CBT for LTC residents with pain and comorbid physical or cognitive impairments, aiming to help clinicians meet the challenges of modifying CBT for this special population. While this chapter highlights the kinds of modifications required to accommodate the physical and cognitive impairments common in LTC settings, the approaches presented herein are to a large extent also applicable to community-dwelling older adults across the spectrum of ability and disability.