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Trindade IA, Guiomar R, Carvalho SA, et al. Efficacy of Online-Based Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-Analysis. J Pain. 2021 Apr 20. pii: S1526-5900(21)00207-8. doi: 10.1016/j.jpain.2021.04.003. (Systematic review)
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.

Ratings
Discipline Area Score
Psychologist 7 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

As a family physician, I find this interesting but the small number of studies and some methodological issues suggests caution.

Physician rater

These are small effect sizes indicating the limitations of this intervention.

Physician rater

This article analyses the results of 5 trials examining Acceptance & Commitment Therapy in chronic painful conditions. The results, showing a small improvement in pain interference after 6 months with no effect on any other parameters after this time, are of virtually no clinical significance. In the end, there are insufficient controlled studies examining this treatment in chronic pain to carry out such an analysis but this study implies that this treatment is largely ineffective.

Psychologist rater

This systematic review of on line acceptance and commitment therapy adds to the evidence that e-health approaches are efficacious. The need for better methods, comparisons with face to face therapy and more analysis of variables that affect outcome is warranted.
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