Internet-Delivered Acceptance and Commitment Therapy for Adolescents with Chronic Pain and Their Parents: A Nonrandomized Pilot Trial

Abstract

Background Acceptance and Commitment Therapy (ACT) is an empirically supported treatment for chronic pain in adults. There is also a small but growing evidence base of ACT for pediatric chronic pain. However, because of limited access to psychological treatment for pain, and geographical distances from pain facilities, many patients will not receive such treatment. Objective The aim of the study was to evaluate the feasibility and preliminary effects of an internet-delivered ACT for adolescents with chronic pain, and their parents. Methods In this nonrandomized pilot study 28 self-recruited adolescents, aged 13–17 years, received 8 weeks of internet-delivered ACT, while outcomes were assessed at pre-, posttreatment, and at follow-up (17–25 weeks). Parents of the adolescents received an 8-week internet-delivered parental program, and their outcomes were assessed at the same timepoints. Both treatments were guided by a therapist experienced in ACT and chronic pain. Results Some threats to feasibility were identified such as slow recruitment rate, low compliance and a delay in completion of follow-up assessments. Preliminary outcome evaluation showed that adolescents showed a large significant improvement on their main outcome (pain interference, d = 1.09), and parents a medium improvement on their main outcome, pain reactivity (d = 0.70). Improvements were also seen in adolescents’ depressive symptoms and insomnia severity. Conclusion The preliminary results of internet-delivered ACT are promising with regards to improvements in adolescent and parent outcome. Measures to improve feasibility are needed prior to conducting a larger randomized trial.

Cognition and Pain: A Review

“…Studies have shown an increase in the EC levels even after short-term meditation practice, providing evidence of the analgesic potential of mindbody therapies (Sadhasivam et al, 2020). Understanding and individualizing the treatment and matching it to the patient's requirement can improve treatment response, adherence, and outcomes (Day et al, 2020;Zetterqvist et al, 2020). Considering at-home practices and online modules can improve reach and compliance with mindfulness-based therapies (Day et al, 2020;Zetterqvist et al, 2020).…”

Rapid Transition to Virtual Assessment and Treatment in an Interdisciplinary Randomized Clinical Trial for Youth With Chronic Pain

“…Digital delivery of pain management treatments offers promise for expanding access to treatment beyond the context of a global pandemic. Before COVID-19, considerable research was being conducted to develop digital solutions and assess the feasibility and effectiveness of interventions for youth with chronic pain delivered via the Internet and smartphone/mobile technologies 34–38. Feasibility and effectiveness of these remotely delivered health interventions for youth with chronic pain have been demonstrated via clinical trials, with effectiveness demonstrated in real-world settings as well 39.…”

“…Before COVID-19, considerable research was being conducted to develop digital solutions and assess the feasibility and effectiveness of interventions for youth with chronic pain delivered via the Internet and smartphone/mobile technologies. [34][35][36][37][38] Feasibility and effectiveness of these remotely delivered health interventions for youth with chronic pain have been demonstrated via clinical trials, with effectiveness demonstrated in real-world settings as well. 39 Yet, there are still many future directions to be explored within the context of digital behavioral health care delivery.…”

Chronic Pediatric Pain and Mental Illness During the COVID-19 Era: A Case Report From Inpatient Child Psychiatry Unit

“…There were short-term pain decreases with headaches, but the results did not last for more than at least three months. However, wait times for pain clinics were reported to be around 197.5 days, and virtual CBT might allow teenagers to receive psychiatric care geared toward the management of their chronic pain more quickly and at a reduced cost [ 19 ]. In an Internet-based setting, acceptance and commitment therapy has shown favored efficacy in treating child and adolescent chronic pain and following related domains, including depressive symptoms and psychological inflexibility [ 20 ].…”