New generation psychological treatments in chronic pain

Abstract

Chronic pain conditions are common and have a considerable impact on health and wellbeing. This impact can be reduced by cognitive behavioral therapy (CBT), the most commonly applied psychological approach to chronic pain. At the same time, CBT continues to develop, and now includes what is sometimes called “third wave” CBT. In this review, we examine the evidence for application of acceptance and commitment therapy (ACT), a principal example of this new wave or latest generation of treatment approaches, in people with chronic pain. We identified 25 randomized controlled trials of ACT for adults with chronic pain. Across the included trials, small to large effect sizes favoring ACT were reported for key outcomes including pain interference, disability, depression, and quality of life. Evidence from three studies provided some support for the cost effectiveness of ACT for chronic pain. Evidence also supported the mediating role of theoretically consistent processes of change (psychological flexibility) in relation to treatment outcomes. Investigation of moderators and predictors of outcomes was limited and inconsistent. In future, a greater focus on process based treatments is recommended. This should include continued identification of evidence based processes of change, and research methods more suited to understanding the experience and needs of individual people.

Predictors of outcomes following interdisciplinary acceptance and commitment therapy for chronic pain: Profiling psychological flexibility

“…Acceptance and commitment therapy (ACT) has been applied to chronic pain, and growing evidence demonstrates its benefit (Hughes et al, 2017; McCracken et al, 2022; Trindade et al, 2021). ACT is a specific form of cognitive behavioural therapy (CBT) based on the psychological flexibility (PF) model.…”

Quality of life in adolescents with chronic non-traumatic knee pain: An analysis of 323 adolescents with Patellofemoral Pain and Osgood-Schlatter Disease

“…Adolescents' diverse clinical presentation may provide a plausible explanation for current insufficient evidence of recommending specific treatments in the context of non-traumatic knee pain 24,48 . It has been suggested that current management for adolescents CMP may benefit from higher degree of personalization that fit into each individual context 6,21 . The current study adds new insights into this field of adolescents suffering from PFP or OSD.…”

Management of Co-Occurring SUD and Chronic Pain

“…Ref. [54] Enhancing insight into the role of a patient's thoughts, emotions, and behaviors on functional capacity and subjective level of pain is of paramount importance and may be approached with specific counseling techniques, which are often provided by mental health specialists but may also be used by medical providers such as pain or addiction medicine specialists, or primary care providers [56]. Motivational interviewing is a patient-centered approach that encourages the patient to undergo behavior change in a manner consistent with their own choice and empowerment.…”