Doctor, can you tell me about Acceptance and Commitment Therapy (ACT) for chronic pain?

For people with chronic pain, ACT has been shown to improve pain acceptance, quality of life, and pain-related functioning. It may also reduce pain intensity, anxiety, and depression.

What is the evidence?

SUMMARY OF FINDINGS

ACT vs usual care or wait list or another treatment

Outcome	Number of Studies (no. of people)	Effect	Quality of Evidence
Pain acceptance	16 (1543)	12 out of 16 studies found that pain acceptance was increased by a large amount by ACT compared to usual care/wait list/another treatment	unclear to moderate
Quality of life	16 (1612)	8 out of 16 studies found that Quality of Life was improved by a moderate amount by ACT compared to usual care/wait list/another treatment	unclear to moderate
Pain-related functioning	17 (1711)	14 out of 17 studies found that pain-related functioning was improved by a large amount by ACT compared to usual care/wait list/another treatment	unclear to moderate
Pain intensity	17 (1640)	7 out of 17 studies found that pain intensity was reduced by a moderate amount by ACT compared to usual care/wait list/another treatment	unclear to moderate
Anxiety	12 (1430)	6 out of 12 studies found that anxiety was reduced by a moderate amount by ACT compared to usual care/wait list/another treatment	unclear to moderate
Depression	17 (1699)	14 out of 17 studies found that depression was reduced by a large amount by ACT compared to usual care/wait list/another treatment	unclear to moderate

What kind of study was this?

This was a systematic review of 21 randomized controlled trials published up to July 2022.

Who? This review included 1962 adults (average age 40 to 60 years; majority were female) with chronic pain (pain for longer than 3 months). Fifteen of the studies included people with different types of chronic pain while six studies included people with the same type of chronic pain (for example, fibromyalgia, whiplash-associated disorders, neuropathic pain). People with chronic headaches and cancer-related pain were excluded.

What? The reviewers included studies that compared ACT with usual care, waiting list, or another treatment.

ACT	vs	Usual care/Wait List/Another treatment
ACT: a type of talking therapy that focuses on accepting pain and identifying goals and behaviours to help the person with pain live their life ACT was provided in 7 to 8 weekly sessions (ranging from 2 to 12 sessions) with an average length of 810 minutes (ranging from 120 to 1620 minutes). The sessions were in person for 12 studies, online for 1 study, by phone for 1 study, and through a self-help book format for 1 study. Follow-up after study was complete ranged from 3 to 12 months.		Usual care: 7 studies Wait List for ACT: 8 studies Another treatment: cognitive behavioural therapy, applied relaxation, physical therapy, minimal support group, expressive writing Follow-up after study was complete ranged from 3 to 12 months.

ACT

Usual care/Wait List/Another treatment

ACT: a type of talking therapy that focuses on accepting pain and identifying goals and behaviours to help the person with pain live their life

ACT was provided in 7 to 8 weekly sessions (ranging from 2 to 12 sessions) with an average length of 810 minutes (ranging from 120 to 1620 minutes). The sessions were in person for 12 studies, online for 1 study, by phone for 1 study, and through a self-help book format for 1 study.

Follow-up after study was complete ranged from 3 to 12 months.

Usual care: 7 studies

Wait List for ACT: 8 studies

Another treatment: cognitive behavioural therapy, applied relaxation, physical therapy, minimal support group, expressive writing

Follow-up after study was complete ranged from 3 to 12 months.

Why was this research done?

Acceptance and Commitment Therapy teaches people to reduce how much chronic pain interferes with their daily life. Instead of fighting the pain, they are taught how to accept it, and to focus on what they can do to keep living their live. The reviewers wanted to know if ACT would reduce chronic pain compared to usual care, people on a waiting list, or another treatment. They found that ACT was better than the control groups for all of the outcomes they tested. Concerns about this review include the wide variety in how the studies were performed and the unclear to moderate quality of the studies.

This Evidence Summary is based on the following article:

Ma TW, Yuen AS, Yang Z. The Efficacy of Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-analysis. Clin J Pain. 2023 Mar 1;39(3):147-157. doi: 10.1097/AJP.0000000000001096. PubMed

Published: Friday, June 23, 2023

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2024/12/21.

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