Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
INPUT Pain Management Unit, Guy's & St Thomas' NHS Foundation Trust, London, UK.
Eur J Pain. 2021 Aug;25(7):1493-1507. doi: 10.1002/ejp.1762. Epub 2021 Mar 26.
Neuropathic pain negatively affects quality of life among people living with HIV (PLWH). This study examined the feasibility of conducting a full-scale randomized-controlled trial of online acceptance and commitment therapy ("ACT OPEN") for neuropathic pain in PLWH.
Using a parallel-groups design, thirty-eight participants were randomized to ACT OPEN or a waitlist control (2:1). Participants completed standard self-report outcome measures at baseline, and two- and five-months post-randomization. Participants were aware of their allocation, but assessment was blinded.
Twenty-five participants were randomized to ACT OPEN and 13 to the control (of 133 referrals). ACT OPEN completion was 69% and two-month trial retention was 82%. Treatment credibility and satisfaction scores for ACT OPEN were comparable to scores reported in previous trials of cognitive-behavioural treatments for pain. Four adverse events were reported during the study, including one serious adverse event; all of these were unrelated to the research procedures. Small to moderate effects and 95% confidence intervals suggest that the true effect may favour ACT OPEN for improvements in pain intensity/interference and depression.
A full-scale RCT of online ACT for pain management in PLWH may be feasible with refinements to trial design to facilitate recruitment.
Research on pain management in people living with HIV has primarily focused on pharmacological treatments with limited success. This is the first study to show the potential feasibility of a psychological treatment based on acceptance and commitment therapy delivered online and tailored for pain management in people with HIV ("ACT OPEN"). ACT OPEN may be a promising treatment in this population and further evaluation in a full-scale randomized-controlled trial appears warranted.
The trial was registered (clinicaltrials.gov; NCT03584412).
神经病理性疼痛会降低 HIV 感染者（PLWH）的生活质量。本研究旨在检验在线接受与承诺疗法（"ACT OPEN"）治疗 PLWH 神经病理性疼痛的全规模随机对照试验的可行性。
采用平行分组设计，将 38 名参与者随机分配至 ACT OPEN 组或等待对照（2:1）组。参与者在基线、随机分组后 2 个月和 5 个月时完成标准的自我报告结局测量。参与者知晓自己的分组情况，但评估是盲法的。
25 名参与者被随机分配至 ACT OPEN 组，13 名参与者被随机分配至对照组（133 名转诊者中的 13 名）。ACT OPEN 的完成率为 69%，2 个月的试验保留率为 82%。ACT OPEN 的治疗可信度和满意度评分与之前疼痛认知行为治疗试验报告的评分相当。研究期间报告了 4 起不良事件，包括 1 起严重不良事件；所有这些都与研究程序无关。小到中等的效应和 95%置信区间表明，真实效应可能有利于 ACT OPEN 改善疼痛强度/干扰和抑郁。
对 PLWH 进行在线 ACT 疼痛管理的全规模 RCT 是可行的，可对试验设计进行改进以促进招募。
HIV 感染者的疼痛管理研究主要集中在药物治疗上，但效果有限。这是第一项表明基于接受和承诺疗法的在线心理治疗具有潜力的研究，该治疗针对 HIV 感染者的疼痛管理进行了调整（"ACT OPEN"）。ACT OPEN 可能是该人群有前途的治疗方法，进一步在全规模随机对照试验中进行评估似乎是合理的。
该试验已在（clinicaltrials.gov；NCT03584412）注册。
