Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis

Sung-Dong Hwang; Sang-Eun Jun; Hee-Sook Kang; Sung-Dong Hwang; Sang-Eun Jun

doi:10.12934/jkpmhn.2019.28.3.271

Journal List > J Korean Acad Psychiatr Ment Health Nurs > v.28(3) > 1134596

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Hwang, Jun, Kang, Hwang, and Jun: Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis

Original Article

J Korean Acad Psychiatr Ment Health Nurs 2019;28(3):271-285.

Published online: 17 September 2019

DOI: https://doi.org/10.12934/jkpmhn.2019.28.3.271

Effectiveness of Acceptance and Commitment Therapy for Chronic Pain Patients: A Systematic Review and Meta-Analysis

Sung-Dong Hwang², Sang-Eun Jun³, Hee-Sook Kang¹, Sung-Dong Hwang², Sang-Eun Jun³

¹Assistant professor, Department of Nursing, Sunlin University, Pohang, Korea

²Professor, College of Social Sciences, Kyungpook National University, Daegu, Korea

³Associate Professor, College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Jun, Sang-Eun https://orcid.org/0000-0002-1988-0357 College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3923, Fax: +82-53-580-3916, E-mail: sejun2@gw.kmu.ac.kr

Received 28 June 20191 September 2019 Accepted 19 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The aims of this study was to evaluate the effects of acceptance and commitment therapy (ACT) for chronic pain patients.

Methods

Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched the Cochrane Library, CINAHL, EMBASE, OVID, PubMed and Korean databases to identify randomized controlled trials published through May 2019. To estimate the effect size, a metaanalysis of the studies was performed using the R program, and the risk of bias was assessed using the Cochrane's Risk of Bias tool for randomized studies.

Results

A total of 11 studies were included in this study. Studies were heterogeneous, and random effects models were used in the analyses. ACT was effective for improving pain (g=-0.40, 95%CI:-0.69~-1.12, p<.001, I²=80%), pain acceptance (g=1.24, 95% CI:0.41~2.05, p<.001, I²=95%), anxiety (g=-0.47, 95% CI:-0.81~-0.13, p<.001, I²=84%), depression (g=-0.52, 95% CI:-0.85~-0.19, p<.001, I²=85%), and quality of life (g=1.14, 95% CI:0.11~2.17, p<.001, I²=95%).

Conclusion

Our study findings of the ACT seems to be effective for improving pain, pain acceptance, anxiety, depression, and quality of life in patients with chronic pain. Additionally, ACT may be useful for reducing barriers to therapy, and various studies should be attempted.

Keywords: Acceptance and commitment therapy, Chronic pain, Effectiveness, Systematic review, Metaanalysis

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Figure 1.

Flow diagram for study selection process.

Figure 2.

Risk of bias in included studies.

Figure 3.

Forest plot of metaanalysis on effects of ACT.

Table 1.

Characteristics of Studies Included Study

1st Author (year)	Country	Setting	Age M±SD or range (mean)>	Participants			Intervention	Comparison	Outcome measures
				Type	Exp.	Cont.	Type / Week / Min / Session / Frequency
				Type	(n)	(n)	Type / Week / Min / Session / Frequency
Johnston (2010)	NZL	Hosp. &	20~84 (43)	Chronic pain	12	12	Self-help book / 6 / - / 8 / 1	WL	Pain (SF-MPQ)
		Comm.					+ telephone / 6 /- / - / 1		Acceptance (CPAQ)
									QOL (QOLI)
									Depression (CMDI)
									Anxiety (BAI)
Thorsell (2011)	SWE	Comm.	46.00±12.30	Chronic pain	61	54	Self –manual + CD +	AR	Pain (VAS)
							telephone / 6 / 6 / 30 / 1		Acceptance (CPAQ)
							(Face-to-face / 2 /2 / 90 /1		Depression (HADS)
							initial session, concluding		Anxiety (HADS)
							session)		QOL (SWLS)
Wetherell (2011)	USA	Comm.	54.90±12.50	Chronic pain	57	57	Group / 8 / 90 / 8 / 1	CBT	Pain (BPI)
									Acceptance (CPAQ)
									Depression (BDI-II)
									Anxiety (PASS)
									QOL (SF-12)
Buhrman (2013)	SWE	Comm.	49.10±10.34	Chronic pain	38	38	Internet / 7 / - / 7 / 1	Internet for pain to	Pain (MPI)
							(online + telephone 2 times,	discussion	Acceptance (CPAQ)
							within 30 minutes)		QOL (QOLI)
									Depression (HADS)
									Anxiety (HADS)
McCracken (2013)	UK	Hosp.	58.00±12.80	Chronic pain	37	36	Group / 4 / 240 / 12~13 / 3	TAU	Pain (NRS)
									Acceptance (CPAQ)
									Depression (PHQ-9)
Wicksell (2013)	SWE	Hosp.	45.10±6.60	Fibromyalgia	23	17	Group / 12 / 90 / 12 / 1	WL	Pain (VAS)
									Depression (BDI)
									Anxiety (STAI-S)
									QOL (SF-36)
Luciano (2014)	ESP	Hosp.	48.88±5.94	Fibromyalgia	51	52	Group / 8 / 150 / 8 / 1	WL	Pain (VAS)
									Acceptance (CPAQ)
									QOL (EQ-5D)
									Depression (HADS)
									Anxiety (HADS)
Kemani	SWE	Hosp.	40.30±11.40	Longstanding	30	30	Group / 12 / 90 / 12 / 1	AR	Pain (VAS)
(2015)				pain					Acceptance (CPAQ)
									Depression (HADS)
									Anxiety (HADS)
									QOL (SF-12)
Trompetter (2015)	NED	Comm.	52.90±13.30	Chronic pain	82	79	Internet / 9~12 / 15 / 9 /1	WL	Pain (MPI)
							(+email counseling 1/week)		Depression (HADS)
									Anxiety (HADS)
Shin (2018)	KOR	Comm.	77.84±3.22	Chronic pain	25	27	Group / 8 / 90 / 8 / 1	Health education	Pain (BPI)
								program	Depression (HADS)
									Anxiety (HADS)
									QOL (SWLS)
Wiklund (2018)	SWE	Hosp.	54.21±10.15	Chronic pain	100	100	Group / 7 / 120 / 6 / 1	Persistent pain to	Pain (NRS)
				with sleep				discussion	Anxiety (HADS)
				disturbance					Depression (HADS)

AR=applying relaxation; BAI=Beck Anxiety Inventory; BDI=Beck Depression Inventory; BDI-II=Beck Depression Inventory-II; BPI=Brief Pain Inventory; CBT=cognitive-behavioral therapy; CMDI=Chicago Multiscale Depression Inventory; Comm.=community; Cont.=control group; CPAQ=Chronic Pain Acceptance Questionnaire; Exp.=experimental group; EQ-5D=Visual Analogue Scale of EuroQol; ESP=Spain; HADS=Hospital Anxiety and Depression Scale; Hosp.=hospital; KOR=Korea; MPI=Multidimensional Pain Inventory; NED=Netherlands; NRS=Numeral Rating Scale; NZL=New Zealand; PASS=Pain Anxiety Symptoms Scale-Short Form; PHQ-9=Patient Health Questionnaire-9; QOL=quality of life; QOLI=Quality of Life Inventory; SF-12=Medical Outcomes study 12-item Short Form; SF-36=Short Form Health Survey; SF-MPQ=Short-Form McGill Pain Questionnaire; STAI-S=Spielberger Trait-State Anxiety Inventory; SWE=Sweden; SWLS=Satisfaction With Life Scale; TAU=treatment as usual; UK=United Kingdom; USA=United States of America; VAS=Visual Analogue Scale; WL=wait-list.

Table 2.

Subgroup Analysis of Pain

Variables	Categories	k	Hedges's g	95% CI	I² (%)	Qb (p)
Comparison type	Wait list	4	-0.49	-0.98~0.00	83.3	0.17
Comparison type	Others	7	-0.36	-0.74~0.02	75.0	(.675)
Intervention period	8 weeks	3	-0.73	-1.51~0.06	89.4	2.34
	Week＜8 weeks	5	-0.39	-0.87~0.08	83.5	(.309)
	Week＞8 weeks	3	-0.16	-0.40~0.09	0.0
Intervention method	Face to face (group)	7	-0.34	-0.72~-0.04	81.1	14.50
	Mixed (Face to face + self-help)	1	-1.12	-1.51~-0.73	-	(＜.001)
	Self-help	3	-0.24	-0.48~0.00	0
Intervention setting	Hospital	5	-0.26	-0.69~0.16	79.9	0.95
	Community	5	-0.51	-0.98~-0.05	85.3	(.162)
	Community & Hospital	1	-0.63	-1.43~0.16	-

k=number of studies; CI=confidence interval; Q_b=Q-value between subgroups.

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