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The Effect of Humor Therapy on Relieving Quality and Fear of Pain in Elderly Residing Nursing Homes: A Randomized Clinical Trial

Shohre Behrouz, Seyed Reza Mazloom, Hadi Kooshiar, Negar Asgharipour, Nahid Aghebati, Hamid Reza Behnam Vashani




Introduction: Chronic pain is common in the elderly. Distraction is one of the important uses of cognitive-behavioral techniques and humor is one of the distraction techniques used in pain control. The aim of the present study was to determine the impact of humor therapy (HT) on quality and fear of pain in nursing homes. Methods: We conducted a randomized clinical trial study on 55 elderly who had experienced chronic pain for at least 3 months and residing in nursing homes in Mashhad, Iran, 2016. The sampling was of convenience type as well as random allocation of nursing homes to two groups; the one receiving HT (n = 28) and a control group (n = 27) living in two similar nursing homes. The experimental group received 6 sessions of humor therapy over 6 weeks and the control group received the routine care. To this end, pain quality and fear of pain were assessed at the first, after the 3rd and 6th sessions in both groups respectively using the McGill Pain Questionnaire and Fear of Pain Questionnaire. The main data were also compared using the Mann-Whitney U test. Results: Total pain quality and fear of pain before the study was homogeneous in both groups (P > 0.05); but after 6th sessions in humor therapy the score of total pain quality decrease from 3.5 ± 1.1 to 2.4±0.7 (P < 0.001) and the score of fear of pain decrease from 36.0 ± 1.4 to 30.6 ± 0.8 (P < 0.05). These results were not significant in control group (P > 0.05). Conclusions: HT as a low-cost method can be an effective way to reduce the quality and fear of pain in elderly pain.


Pain Management, Laughter Therapy, Chronic Pain, Aged


Van Lerberghe W. The world health report 2008: primary health care: now more than ever. Geneva: World Health Organization; 2008.

Tourani S, Behzadifar M, Martini M, Aryankhesal A, Taheri Mirghaed M, Salemi M, et al. Health-related quality of life among healthy elderly Iranians: a systematic review and meta-analysis of the literature. Health Qual Life Outcomes. 2018;16(1):18. doi: 10.1186/s12955-018-0845-7 pmid: 29347951

Arnstein P, Herr KA, Butcher HK. Evidence-Based Practice Guideline: Persistent Pain Management in Older Adults. J Gerontol Nurs. 2017;43(7):20-31. doi: 10.3928/00989134-20170419-01 pmid: 28651032

Pryor WA, Stanley JP, Blair E. Autoxidation of polyunsaturated fatty acids: II. A suggested mechanism for the formation of TBA-reactive materials from prostaglandin-like endoperoxides. Lipids. 1976;11(5):370-9. doi: 10.1007/bf02532843 pmid: 1271974

AGS Panel on Persistent Pain in Older Persons. The management of persistent pain in older persons. J Am Geriatr Soc. 2002;50(6 Suppl):S205.

Asghari A, Ghaderi N, Ashory A. The prevalence of pain among residents of nursing homes and the impact of pain on their mood and quality of life. Arch Iran Med. 2006;9(4):368-73. pmid: 17061612

Coffey VG, Hawley JA. The molecular bases of training adaptation. Sports Med. 2007;37(9):737-63. doi: 10.2165/00007256-200737090-00001 pmid: 17722947

Simon LS. Relieving pain in America: A blueprint for transforming prevention, care, education, and research. J Pain Palliat Care Pharmacother. 2012;26(2):197-8. pmid: 22553896

Barker RL. Fear and Phobias. Ment Health Elderly. 2010:271.

Pincus T, Smeets RJ, Simmonds MJ, Sullivan MJ. The fear avoidance model disentangled: improving the clinical utility of the fear avoidance model. Clin J Pain. 2010;26(9):739-46. doi: 10.1097/AJP.0b013e3181f15d45 pmid: 20842017

Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999;19(1):97-119. pmid: 9987586

Reid MC, Bennett DA, Chen WG, Eldadah BA, Farrar JT, Ferrell B, et al. Improving the pharmacologic management of pain in older adults: identifying the research gaps and methods to address them. Pain Med. 2011;12(9):1336-57. doi: 10.1111/j.1526-4637.2011.01211.x pmid: 21834914

Corran TM, Helme RD, Gibson SJ. Multidisciplinary assessment and treatment of pain in older persons. Topics Geriatr Rehabil. 2001;16(3):1-11.

Turner JA, Chapman CR. Psychological interventions for chronic pain: a critical review. II. Operant conditioning, hypnosis, and cognitive-behavioral therapy. Pain. 1982;12(1):23-46. doi: 10.1016/0304-3959(82)90168-3 pmid: 7036050

Vowles KE, Gross RT. Work-related beliefs about injury and physical capability for work in individuals with chronic pain. Pain. 2003;101(3):291-8. doi: 10.1016/s0304-3959(02)00337-8 pmid: 12583872

Melzack R, Wall PD, editors. Pain mechanisms: a new theory: a gate control system modulates sensory input from the skin before it evokes pain perception and response. Pain Forum; 1996: Elsevier.

Fry WF, Jr. The physiologic effects of humor, mirth, and laughter. JAMA. 1992;267(13):1857-8. doi: 10.1001/jama.267.13.1857 pmid: 1545471

Torrance N, Smith BH, Bennett MI, Lee AJ. The epidemiology of chronic pain of predominantly neuropathic origin. Results from a general population survey. J Pain. 2006;7(4):281-9. doi: 10.1016/j.jpain.2005.11.008 pmid: 16618472

Capps D. Religion and humor: Estranged bedfellows. Pastor Psychol. 2006;54(5):413-38.

Senn SS. Statistical issues in drug development: John Wiley & Sons; 2008.

Tse MM, Lo AP, Cheng TL, Chan EK, Chan AH, Chung HS. Humor therapy: relieving chronic pain and enhancing happiness for older adults. J Aging Res. 2010;2010:343574. doi: 10.4061/2010/343574 pmid: 21151506

Ganz FD, Jacobs JM. The effect of humor on elder mental and physical health. Geriatr Nurs. 2014;35(3):205-11. doi: 10.1016/j.gerinurse.2014.01.005 pmid: 24656050

Song M-S, Park KM, Park H. The effects of laughter-therapy on moods and life satisfaction in the elderly staying at care facilities in South Korea. Kor J Geriatr Nurs. 2013;15(1).

Malakouti K, Fathollahi P, Mirabzadeh A, Salavati M, Kahani S. Validation of geriatric depression scale (GDS-15) in Iran. Res Med. 2006;30(4):361-9.

Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695-9. doi: 10.1111/j.1532-5415.2005.53221.x pmid: 15817019

Khosravi M, Sadighi S, Moradi S, Zendehdel K. Persian-McGill pain questionnaire; translation, adaptation and reliability in cancer patients: a brief report. Tehran Tehran University of Medical Sciences; 2013.

McNeil DW, Rainwater AJ, 3rd. Development of the Fear of Pain Questionnaire--III. J Behav Med. 1998;21(4):389-410. pmid: 9789168

Vala M, Dehghani M, Kiamanesh AR. Validity, reliability and normalization of the fear of pain Questionnaire-Short Form (FPQ-SF). J Kerman Med Sci. 2012;19(2):176-89.

Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287-333. doi: 10.1016/j.ejpain.2005.06.009 pmid: 16095934

Countries With the Best Sense of Humor. Top Ten List: The Top Tens; 2017 [cited 2017 27 Sep]. Available from: https://www.thetoptens.com/countries-best-sense-humor/.

Salmon P. Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory. Clin Psychol Rev. 2001;21(1):33-61. pmid: 11148895

Wood BM, Nicholas MK, Blyth F, Asghari A, Gibson S. Catastrophizing mediates the relationship between pain intensity and depressed mood in older adults with persistent pain. J Pain. 2013;14(2):149-57. doi: 10.1016/j.jpain.2012.10.011 pmid: 23265846

Katz NP, Gammaitoni AR, Davis MW, Dworkin RH, Lidoderm Patch Study G. Lidocaine patch 5% reduces pain intensity and interference with quality of life in patients with postherpetic neuralgia: an effectiveness trial. Pain Med. 2002;3(4):324-32. doi: 10.1046/j.1526-4637.2002.02050.x pmid: 15099237

Ebrahimi-Nejad G. An Investigation of Personality, Coping and emotion in patients with persistent pain. Clinical Psyulogical PhD. Glasgow, Scotland: Glasgow University; 1997.

Siedliecki SL, Good M. Effect of music on power, pain, depression and disability. J Adv Nurs. 2006;54(5):553-62. doi: 10.1111/j.1365-2648.2006.03860.x pmid: 16722953

Gomez Gallego M, Gomez Garcia J. Music therapy and Alzheimer's disease: Cognitive, psychological, and behavioural effects. Neurologia. 2017;32(5):300-8. doi: 10.1016/j.nrl.2015.12.003 pmid: 26896913

DOI: https://doi.org/10.22037/anm.v28i3.22720