Efficacy of online-based acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis

Trindade, Inês A. ORCID: https://orcid.org/0000-0003-1208-2077, Guiomar, Raquel ORCID: https://orcid.org/0000-0001-9611-1167, Carvalho, Sérgio A., Duarte, Joana, Lapa, Teresa, Menezes, Paulo ORCID: https://orcid.org/0000-0002-4903-3554, Nogueira, Maria Rita ORCID: https://orcid.org/0000-0001-8783-3619, Patrão, Bruno ORCID: https://orcid.org/0000-0002-0251-9047, Pinto-Gouveia, José ORCID: https://orcid.org/0000-0002-4505-8367 and Castilho, Paula ORCID: https://orcid.org/0000-0003-1864-3146 (2021) Efficacy of online-based acceptance and commitment therapy for chronic pain: a systematic review and meta-analysis. Journal of Pain, 22 (11). pp. 1328-1342. ISSN 1526-5900

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Abstract

Acceptance and Commitment Therapy (ACT) has been widely tested for chronic pain, with demonstrated efficacy. Nevertheless, although there is meta-analytical evidence on the efficacy of face-to-face ACT, no reviews have been performed on online ACT in this population. The aim of this meta-analysis is to determine the efficacy of online ACT for adults with chronic pain, when compared with controls. PubMed, PsycINFO, CENTRAL, and Web of Knowledge were searched for randomized controlled trials (RCTs) of online-delivered ACT for chronic pain. Effects were analyzed at post-treatment and follow-up, by calculating standardized mean differences. Online-delivered ACT was generally favored over controls (5 RCTs, N = 746). At post-treatment, medium effects for pain interference and pain acceptance, and small effects for depression, mindfulness, and psychological flexibility were found. A medium effect for pain interference and acceptance, and small effects for pain intensity, depression, anxiety, mindfulness, and psychological flexibility were found at follow-up. ACT-related effects for pain interference, pain intensity, mindfulness, and anxiety increased from post-treatment to follow-up. Nevertheless, the current findings also highlight the need for more methodologically robust RCTs. Future trials should compare online ACT with active treatments, and use measurement methods with low bias. Perspective: This is the first meta-analytical review on the efficacy of online ACT for people with chronic pain. It comprises 5 RCTs that compared online ACT with active and/or inactive controls. Online ACT was more efficacious than controls regarding pain interference, pain intensity, depression, anxiety, mindfulness, and psychological flexibility.