Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis

Abstract

Acceptance-based interventions such as mindfulness-based stress reduction program and acceptance and commitment therapy are alternative therapies for cognitive behavioral therapy for treating chronic pain patients. To assess the effects of acceptance-based interventions on patients with chronic pain, we conducted a systematic review and meta-analysis of controlled and noncontrolled studies reporting effects on mental and physical health of pain patients. All studies were rated for quality. Primary outcome measures were pain intensity and depression. Secondary outcomes were anxiety, physical wellbeing, and quality of life. Twenty-two studies (9 randomized controlled studies, 5 clinical controlled studies [without randomization] and 8 noncontrolled studies) were included, totaling 1235 patients with chronic pain. An effect size on pain of 0.37 was found for the controlled studies. The effect on depression was 0.32. The quality of the studies was not found to moderate the effects of acceptance-based interventions. The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives. More high-quality studies are needed. It is recommended to focus on therapies that integrate mindfulness and behavioral therapy. Acceptance-based therapies have small to medium effects on physical and mental health in chronic pain patients. These effects are comparable to those of cognitive behavioral therapy.

Mindfulness Meditation-Based Intervention Is Feasible, Acceptable, and Safe for Chronic Low Back Pain Requiring Long-Term Daily Opioid Therapy

“…Development of strategies for identifying those at risk for nonadherence and boosting their engagement during and after the intervention may extend the potential benefits of MM practice to a larger group of patients. The perceived safety of MM-based interventions 18,19,27,49 was corroborated by this research. It is in stark contrast to opioid therapy, which has been linked to dose-dependent harms.…”

“…4 Although research on the efficacy of MM-based interventions for reducing pain is promising, existing evidence on MM's effects for pain and/or function in chronic noncancer pain is inconclusive and based on a limited number of rigorous RCTs. 27,34,35,49 In addition, there is an overall scarcity of research on long-term efficacy of therapeutic modalities, including MM and CBT, in opioid-treated populations. 5,18,19,27,34,35,49 Although MM modalities are overall considered feasible, acceptable, and safe, these aspects of MM interventions have not been well explored in, and evidence on their efficacy is insufficient for, opioid-treated CLBP.…”

“…27,34,35,49 In addition, there is an overall scarcity of research on long-term efficacy of therapeutic modalities, including MM and CBT, in opioid-treated populations. 5,18,19,27,34,35,49 Although MM modalities are overall considered feasible, acceptable, and safe, these aspects of MM interventions have not been well explored in, and evidence on their efficacy is insufficient for, opioid-treated CLBP. 27,28 Examining the details of MM practice is crucial for discerning whether particular practice patterns have a differential health impact.…”

The Psychological Flexibility Model: A Basis for Integration and Progress in Psychological Approaches to Chronic Pain Management

“…1 A meta-analysis of "acceptance-based" treatment that included both ACT and mindfulness-based treatments concluded that these methods currently appear equally effective to standard CBT for chronic pain. 80 ACT is listed as an empirically supported treatment with "strong research support" for general chronic pain by the organization within the American Psychological Association that determines this. 73 Psychological Flexibility and Chronic Pain 22…”

Functional Analysis With Typically Developing Children: Best Practice or Too Early to Tell?: In Response to Hanley (2012)

“…The effect size for such interventions is impressive (e.g., Haynes et al, 2008;Norton & Price, 2007;Olatunji, Cisler, & Deacon, 2010;Opriş et al, 2012). There are numerous examples of other multicomponent interventions developed without a preintervention functional assessment with documented effectiveness for problems including, but not limited to, depressive disorders (e.g., Cuijpers, Andersson, Donker, & van Straten, 2011;Hans & Hiller, 2013), pain management (e.g., Lunde, Nordhus, & Pallesen, 2009;Veehof, Oskam, Schreurs, & Bohlmeijer, 2011), and childhood conduct problems (Lee, Niew, Yang, Chen, & Lin, 2012;Maughan, Christiansen, Jenson, Olympia, & Clark, 2005). More often than not, these evidencebased interventions have an accompanying implementation manual.…”