Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Eur J Pain. 2021 May;25(5):1012-1030. doi: 10.1002/ejp.1723. Epub 2021 Jan 18.
Studies of Internet-delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT - a novel format of Internet-ACT using daily microlearning exercises - was examined for efficacy compared to a waitlist condition.
Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self-referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post-assessments were completed by 88% (n = 100) of participants. Twelve-month follow-up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention-to-treat-approach.
Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between-group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between-group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1-year follow-up.
Internet-ACT as microlearning may improve a broad range of outcomes in chronic pain.
The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.
针对慢性疼痛的互联网交付接受和承诺疗法（ACT）研究表明，疼痛干扰和疼痛接受方面的积极影响较小到中等。对疼痛强度、抑郁、焦虑和生活质量（QoL）的影响不太有利，对价值观和睡眠的改善则缺乏。在这项随机对照试验中，iACT-一种使用日常微观学习练习的新型互联网 ACT 格式-与等待名单条件进行了疗效比较。
通过自我推荐招募了患有各种慢性疼痛疾病的成年参与者（平均年龄 49.5 岁，疼痛持续时间 18.1 年），并随机分配到 iACT（n=57）或等待名单（n=56）。主要结果是疼痛干扰。次要结果是生活质量、抑郁、焦虑、失眠和疼痛强度。过程变量包括心理灵活性和价值观。88%（n=100）的参与者完成了后期评估。仅 65%（iACT，n=37）的参与者完成了 12 个月的随访评估。使用线性混合模型和意向治疗方法分析治疗效果。
iACT 组在疼痛干扰、抑郁、焦虑、疼痛强度和失眠方面以及心理灵活性和价值观等过程变量方面有显著改善。疼痛干扰（d=0.99）和疼痛强度（d=1.2）的组间效应大小较大，焦虑和抑郁症状的组间效应大小中等，生活质量和失眠的组间效应大小较小。对于过程变量，心理灵活性的组间效应大小较大（d=1.0），价值观的组间效应大小中等。所有改善在 1 年随访时均得到维持。
互联网 ACT 作为微观学习可能会改善慢性疼痛的广泛结果。
该研究评估了一种新的行为治疗方法，对慢性疼痛患者的疼痛干扰、情绪以及疼痛强度有积极影响。这种新颖的数字 ACT 干预形式以简短而经验性的日常学习呈现，可能是一种有前途的方法。
