As researchers strive to find the right psychotherapeutic approaches to best help patients break destructive thought patterns that perpetuate chronic pain, acceptance and commitment therapy (ACT) and psychological flexibility are gaining favor — and evidence.
researchers showed the importance of acceptance in offsetting patient perceptions of injustice, which are known to be strongly associated with pain-related outcomes
When pain becomes chronic, patients can experience many losses: loss of function, loss of employment, and loss of independence.
It’s very intuitive to not feel responsible for it and develop a sense of injustice,” first author Junie Carriere, a PhD candidate in experimental psychology
Conversely, an acceptance of pain has been associated with fewer pain-related difficulties and better quality of life.
Overall, people with high acceptance push forward, mentally and physically. As a result, they experience better health and pain outcomes,” Carriere said.
These findings suggest that perceived injustice and acceptance have significant roles in the degree to which pain interferes with the lives of individuals with chronic pain,” the authors write
Carriere added that “clinicians should be made aware of the detrimental impacts of feelings of injustice on pain outcomes.”
“They may want to identify patients who express high feelings of injustice and consider including acceptance-based therapy as part of their pain management treatment plan,” she said.
Numerous other studies have underscored the role of pain acceptance in chronic pain, and one recent study published in the Journal of Pain in 2015, showed that pain-related acceptance, part of a 5-week outpatient multidisciplinary program of cognitive-behavioral therapy, was the strongest mediator across several different indices of outcome.
In a plenary talk on psychological flexibility and functional contextualism presented at the APS meeting, Lance M. McCracken, PhD, a coauthor on that study, speculated on the additional role of flexibility in shifting the patterns of thought that perpetuate chronic pain.
The broader focus of such efforts is to turn patients away from pain catastrophizing, known to be a critical driver of poor outcomes and continued pain.
The question is how can we undermine it, and should we do battle with catastrophizing, or make peace with it? I think what we’re learning is that making peace is an option, and I think we know how.”
ACT and Telehealth
ACT has been shown to be particularly beneficial for veterans with chronic pain, helping to reduce pain interference and improve quality of life. However, restricted access is a common limitation in preventing patients from getting the help they need.
For the study, the researchers randomly assigned 129 veterans with chronic pain in the Veterans Affairs San Diego Healthcare System to receive 8 weeks of ACT therapy through video conferencing or in-person
On the study’s primary outcome of pain interference on the Brief Pain Inventory, results showed noninferiority of the telehealth approach, with participants in both groups having lower pain inference scores compared with baseline (P < .05), and no significant differences between groups in time-by-treatment interaction.
Despite no significant improvements in sleep or post-traumatic stress disorder between groups, attrition rates were higher in the telehealth group, underscoring one of the key challenges with telemedicine.
“The findings of the present study suggest that ACT for chronic pain delivered [by] telehealth or in-person are comparable, though attrition rates may differ based on delivery type,” the authors concluded.
American Pain Society (APS) 35th Annual Scientific Meeting. Presented May 13, 2016.