The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial

Abstract

Introduction: Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy. Methods: This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22. Results: The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P \ 0.01). Conclusion: The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy. Clinical Trail Registration: This study was registered at the Iranian Registry of Clinical Trials (IRCT20180205038630N4).

Predicting the Quality of Life in Patients With Painful Diabetic Neuropathy (PDN) Based on Pain Severity, Pain Catastrophizing, Pain Acceptance, Depression, Anxiety, and Sleep Disturbance: Assessing the Prevalence of Psychiatric Symptoms in Iranian Patients With PDN.

“…Recently, the rst and corresponding author of this paper conducted extensive research in PDN. In our published works for that project, we found that increasing sleep quality and pain acceptance and reducing pain catastrophizing and depression can reduce PDN symptoms and also increase response to treatment and consequently improve Qol in patients with PDN (8,11).…”

“…The Persian version of the CPAQ also has shown adequate psychometric properties. The assessment of the psychometric properties of the Persian version has shown that the CPAQ had a Cronbach's alpha of 0.89 and test-retest reliability of 0.71 (11).…”

“…Pain catastrophizing is associated with increased disability and decreased Qol in patients with PDN (9). Pharmacological and psychological interventions, at best, relieve only 50% of pain severity (10).Therefore, pain acceptance and reducing pain catastrophizing decrease the severity of disability caused by this attitude; thus widely improve the Qol (11,12).Extensive studies have examined the effectiveness of various treatment methods to improve the Qol of patients with PDN because the primary purpose of diabetes early diagnosis and treatment is to improve the Qol in these patients (12,13). There are several de nitions of Qol.…”

“…Also, the lack of improvement in sleep problems is an obstacle to improving other symptoms in these patients (16).Overall, problems related to pain, depression, anxiety, and sleep disturbance lead to a severe decline in Qol (as a primary goal of therapeutic interventions) in patients with PDN. However, various studies have targeted a number of these symptoms in various ways (6,8,11,14).Therefore, the contribution of each one in reducing these patients' Qol has not been determined. It has been associated with limitations such as meager sample size (less than 60 people) (18,19), failure to conduct individual interviews (9), and lack of examination in psychological variables (20).…”

A Consideration of the Psychological Aspects to Managing Patients with Painful Diabetic Neuropathy: An Insight into Pain Management Services at a Tertiary Centre in the UK

“…Acceptance and commitment therapy (ACT) is a psychological modality that has been used with increasing interest in chronic pain. It is considered a third-wave of CBT and can be used alongside more traditional CBT [41][42][43]. Traditional CBT approaches are focused on identifying thoughts, feelings and behaviours that may drive and maintain presenting psychological difficulties.…”