Early Changes in Pain Acceptance Predict Pain Outcomes in Interdisciplinary Treatment for Chronic Pain

Abstract

Studies have shown that pain acceptance is associated with a better pain outcome. The current study explored whether changes in pain acceptance in the very early treatment phase of an interdisciplinary cognitive-behavioral therapy (CBT)-based treatment program for chronic pain predict pain outcomes. A total of 69 patients with chronic, non-malignant pain (at least 6 months) were treated in a day-clinic for four-weeks. Pain acceptance was measured with the Chronic Pain Acceptance Questionnaire (CPAQ), pain outcomes included pain intensity (Numeric Rating Scale, NRS) as well as affective and sensory pain perception (Pain Perception Scale, SES-A and SES-S). Regression analyses controlling for the pre-treatment values of the pain outcomes, age, and gender were performed. Early changes in pain acceptance predicted pain intensity at post-treatment measured with the NRS (B = −0.04 (SE = 0.02); T = −2.28; p = 0.026), affective pain perception at post-treatment assessed with the SES-A (B = −0.26 (SE = 0.10); T = −2.79; p = 0.007), and sensory pain perception at post-treatment measured with the SES-S (B = −0.19 (SE = 0.08); T = −2.44; p = 0.017). Yet, a binary logistic regression analysis revealed that early changes in pain acceptance did not predict clinically relevant pre-post changes in pain intensity (at least 2 points on the NRS). Early changes in pain acceptance were associated with pain outcomes, however, the impact was beneath the threshold defined as clinically relevant.

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

“…Interdisciplinary approaches to pain concentrated on the biopsychosocial model. This model emphasizes psychological factors in pain perception, such as thoughts, emotions, and behaviors [ 1 – 3 ]. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), pain disorders form an independent classification of psychiatric disorders.…”

Depression Predicts Chronic Pain Interference in Racially Diverse, Income-Disadvantaged Patients

“…This may be due to the more comprehensive and functional nature of the assessment of interference compared with average pain and pain severity. A prior study investigating chronic pain perception and acceptance found that early changes in pain acceptance were associated with key pain outcomes, yet not associated with pain intensity during the 4-week program [25]. Although changes in depression symptomology may not impact pain severity, they may be a robust indicator of how pain impacts everyday life.…”

Lipoedema and Pain: What is the role of the psyche? – Results of a pilot study with 150 patients with Lipoedema

“…Psychotherapy such as cognitive behavioural therapy (CBT) [35,36], acceptance and commitment therapy (ACT) [37,38], eye movement desensitisation and reprocessing (EMDR) [39], and "pain neuroscience education" (PNE) [33] has high significance internationally in the treatment of patients with pain, as mentioned in Section 4. It goes almost without saying that patients with lipoedema may also benefit from these approaches.…”

“…Therapies that are well-researched in the field of interdisciplinary treatment include cognitive behavioural therapy (CBT) [35,36], which allows a breakthrough in the vicious circle of fear and avoidance, and attention-based acceptance and commitment therapy (ACT), which is used to increase psychological flexibility. Both of these therapies have effects on the severity of pain and improve depression and the quality of life [37,38].…”