Acceptance, Flexibility Key in Chronic Pain Battle

Acceptance, Flexibility Key in Chronic Pain Battle

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.  

 

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5 thoughts on “Acceptance, Flexibility Key in Chronic Pain Battle

  1. Emily Raven

    I accept I’m sick and have pain. The only injustice I see is when there are meds that work for a person and they are taken away. I think psychology is a great tool when used right, but in the current climate of utter quackery with it in most places (read:pain psychologist instead of your working meds) right now it needs to be reevaluated and implemented along side working therapy.

    Liked by 1 person

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    1. Zyp Czyk Post author

      I’m coming to believe that we’re not all talking about the same pain patients. Those of us on these blogs and advocating have serious pain that we’ve tried to control using all the non-opioid means at our disposal before finally realizing that opioids are the only treatment that is effective.

      Then, there could be some who are just “uncomfortable” with “annoying” pains. I know people who just fall apart when they have sore muscles the day after exercise! I’ve also heard of people who seem to be prescribed too high a dose of opioids and all they can do is sit around in a vacuous stupor, and some who end up falling because their balance is affected. These are the folks all these restrictions are aimed at.

      Unfortunately, generalizations always lead to the most restrictive rules because they assume the worst. The whole situation keeps looking worse and worse. I just try not to think about it and do my best to enjoy whatever pain-controlled days I have left. Beyond that….?

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      1. Emily Raven

        Oh yes definitely! When my stuff was just basically a backache (from working on cars, gardening, etc) and I didn’t know what was to come, I was all over self care, OTC, distracting myself through my second job of art/jewelry making, etc. An ice pack is still my best friend, just now I have to use it bare instead of with cloth between it and my skin (yuck I know… just an example of how I’ve “adapted”) I also don’t do stuff I know will aggravate me, and even though I was a mechanic I now ask for an extra set of hands when working on my personal vehicle and take care when working on the computer or playing video games not to sit funny.

        This is exactly the problem. People with minor stuff are thrown in with us with complex conditions and they wonder why the things that help them don’t help us. Newsflash: we tried all that and are beyond it! (Though I would enjoy a talk with a pain psych after my working treatment is given back. Never know. It’s rare but sometimes people have info I haven’t already mined on the net.)

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  2. Cathy

    Well, since I so far have been blessed with a high tolerance for pain….I don’t need pain meds except for surgeries. But, I do not necessarily agree with you. I think it is good to accept your lot in life on many fronts. But, I watched my identical twin be in severe pain for many years, to the point of being bedridden. SHE SUFFERED & DIED in 2010. Wish she had meet the pain standard, but she probably had reason to be in pain. Unless pain managers can come up with something better , I cannot agree with the above, unless it comes with pain medications for people who need them. We could do a test on people without pain…create pain, say by means of a hammer or whatever tool they would like….do not give them pain management, than let them write this same article. Have a good pain free day!

    Liked by 2 people

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    1. Zyp Czyk Post author

      I agree that opioids are a necessity for many pain patients – like me.

      I tried all kinds of physical and mental “tricks” to manage my pain, but none of that works when the pain is too severe. Opioids just bring it down to a level where all these alternative ideas can work.

      Liked by 1 person

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