Effectiveness of Acceptance and Commitment Therapy in Central Pain Sensitization Syndromes: A Systematic Review

Abstract

Objectives: Acceptance and commitment therapy (ACT) is considered by the American Psychological Association as an evidence-based treatment for a variety of disorders, including chronic pain. The main objective of the present systematic review was to determine the effectiveness of ACT in patients with central pain sensitization syndromes (CPSS). Methods: This systematic review was conducted according to the guidelines of the Cochrane Collaboration and PRISMA statements. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO) international database. The selected articles were evaluated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. Results: The literature search identified 21 studies (including investigations of fibromyalgia syndrome, irritable bowel syndrome, and migraine) eligible for the systematic review. There were no studies regarding the effectiveness of ACT for chronic tension-type headache (CTTH), interstitial cystitis (IC), or temporomandibular disorder (TMD). The evaluation of ROB showed that 12 of the selected studies were of low quality, 5 were of moderate quality, and 4 were high quality. ACT reduces some clinical symptoms, such as anxiety, depression, and pain. This positive effect of ACT might be mediated by pain acceptance, psychological flexibility, optimism, self-efficacy, or adherence to values. ACT showed better results in comparison to non-intervention (e.g., “waiting list”) conditions, as well as pharmacological and psychoeducational interventions. It is not entirely clear whether extended ACT treatments are more advantageous than briefer interventions. Conclusions: There are few studies about the effectiveness of ACT on CPSS. However, ACT seems to reduce subjective CPSS symptoms and improve the health-related quality of life of these patients. The absence of studies on the effectiveness of ACT in CTTH, IC, and TMD, indicate the pressing need for further ACT studies in these CPSS.

Musculoskeletal disorders and orofacial pain: a narrative review

“…It may be beneficial on pain and mouth opening (54). Acceptance and commitment therapies may also help in improvement of health related quality of life (55).…”

Dos pensamentos automáticos aos processos álgicos: uma revisão sobre a utilização das terapias cognitivo-comportamentais na abordagem da dor crónica

“…No caso da ACT aplicada à dor crónica, a abordagem passa não por tentar curar a dor, mas por ajustar as expetativas do doente e mudar o foco e o objetivo do mesmo, de «viver sem nenhuma dor» para «viver o melhor possível com a dor que sente, de acordo com os seus valores pessoais e com os seus objetivos». Têm surgido diversas revisões sistemáticas e meta-análises [27][28][29][30] que defendem que a ACT é eficaz na melhoria da funcionalidade do doente com dor crónica 30 , com aumento da aceitação da sua condição [27][28][29][30] , diminuição dos evitamentos das situações que causam dor 28,29 , redução da ansiedade associada à dor e aumento do otimismo, assim como melhoria da qualidade de vida dos doentes 29 .…”

Migraine in the context of chronic primary pain, chronic overlapping pain disorders, and functional somatic disorders: A narrative review

“…Several authors conclude that there is substantial evidence in favor of biofeedback and psychological/biobehavioral treatments (such as psychoeducation, coping and stress management strategies, cognitive‐behavioral therapies, acceptance and commitment therapy, relaxation or mindfulness techniques), but further research is needed 44,51–55 . The benefit of non‐pharmacological treatments that address central or top‐down processes has also been shown in reviews on central sensitization syndromes, FSS, and bodily distress in general 56–58 . In these reviews, covering a large number of pain and non‐pain conditions, centrally acting pain modulators like tricyclic antidepressants and serotonin noradrenalin reuptake inhibitors appeared to be generally more effective than treatments that primarily address peripheral, for example, nociceptive factors 55,56 …”