Jones Berkeley Sara, Wedin Sharlene, Patidar Seema M, Margolies Skye O, Goetzinger Amy M, Mauck Matthew C, Wasan Ajay D, McCracken Lance M
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States.
Pain Med. 2025 Aug 1;26(8):451-458. doi: 10.1093/pm/pnaf026.
Chronic low back pain (cLBP) typically involves behavior patterns in the development and maintenance of symptoms. Acceptance and Commitment Therapy (ACT) is an evidence-based treatment for chronic pain shown to improve pain-related depression, anxiety, and sleep, as well as pain catastrophizing, pain interference, and levels of reported pain. It has been proven effective when delivered in person or online, but an online therapist-enhanced ACT has not been tested to treat cLBP. This approach may have care delivery advantages while maintaining patient engagement with treatment.
Describe the design and implementation of the therapist-supported, online model of ACT that was evaluated in the Biomarking for Evaluating Spine Treatments (BEST) Trial.
The BEST Trial is a sequential, multiple assignment randomized trial of 4 treatment modalities (exercise and manual therapy; duloxetine; enhanced self-management of pain; and ACT) to inform a precision medicine approach to the treatment of cLBP. The ACT intervention was delivered over the internet via a custom, web-based software platform. The program had three primary components: (1) interactive online sessions consisting of video, audio and self-assessment; (2) therapist sessions via video visits; and (3) ongoing therapist support outside the video visits through a messaging system.
The ACT intervention addresses the need for mental health care integrated with chronic low back pain treatment. The online ACT treatment program with enhanced therapist support was designed to overcome barriers to multimodal care of CLBP and improve a range of treatment outcomes.
CLINICALTRIAL.GOV ID: NCT05396014.
The BEST Trial is registered in ClinicalTrials.gov (NCT05396014): https://clinicaltrials.gov/study/NCT05396014.
慢性下腰痛（cLBP）通常涉及症状发生和维持过程中的行为模式。接纳与承诺疗法（ACT）是一种基于证据的慢性疼痛治疗方法，已证明可改善与疼痛相关的抑郁、焦虑和睡眠，以及疼痛灾难化、疼痛干扰和报告的疼痛程度。该疗法在面对面或在线实施时均已被证明有效，但在线治疗师强化的ACT疗法尚未经过治疗cLBP的测试。这种方法可能在提供护理方面具有优势，同时保持患者对治疗的参与度。
描述在评估脊柱治疗生物标志物（BEST）试验中评估的治疗师支持的在线ACT模型的设计和实施。
BEST试验是一项对4种治疗方式（运动和手法治疗；度洛西汀；增强的疼痛自我管理；以及ACT）进行的序贯、多重分配随机试验，以指导cLBP治疗的精准医学方法。ACT干预通过一个定制的基于网络的软件平台在互联网上进行。该项目有三个主要组成部分：（1）由视频、音频和自我评估组成的交互式在线课程；（2）通过视频问诊进行的治疗师问诊；（3）通过消息系统在视频问诊之外提供持续的治疗师支持。
ACT干预满足了将心理健康护理与慢性下腰痛治疗相结合的需求。具有增强治疗师支持的在线ACT治疗项目旨在克服cLBP多模式护理的障碍，并改善一系列治疗结果。
NCT05396014。
BEST试验已在ClinicalTrials.gov（NCT05396014）注册：https://clinicaltrials.gov/study/NCT05396014 。
