Ma TW, Yuen AS, Yang Z The Efficacy of Acceptance and Commitment Therapy for Chronic Pain: A Systematic Review and Meta-analysis. Clin J Pain. 2023 Mar 1;39(3):147-157. doi: 10.1097/AJP.0000000000001096. (Systematic review)

OBJECTIVES: Previous meta-analyses of a small number of trials showed that acceptance and commitment therapy (ACT) might improve chronic pain. Many new trials have been published afterward, and the factors that may impact the efficacy of ACT are less understood. We, therefore, conducted an updated systematic review with meta-analysis to investigate the efficacy of ACT for people with chronic pain.

METHODS: Randomized controlled trials that investigated the efficacy of ACT in clinical or community setting for adult populations with chronic pain were included. The methodological quality of trials was assessed with the Cochrane Risk of Bias tool. Standardized mean differences between ACT and comparison groups in their effects on 6 outcomes (ie, pain acceptance, quality of life, pain-related functioning, pain intensity, anxiety, and depression) were pooled across studies.

RESULTS: Of the 3171 records identified, 21 trials with 1962 participants were included for analysis. The comparison groups included active treatment and waitlist control/usual care. The standardized mean difference was 0.67 (95% CI: 0.48, 0.87) for pain acceptance, 0.43 (95% CI: 0.29, 0.57) for quality of life, -0.88 (95% CI: -1.14, -0.63) for pain-related functioning, -0.45 (95% CI: -0.62, -0.27) for pain intensity, -0.35 (95% CI: -0.54, -0.15) for anxiety, and -0.74 (95% CI, -0.98, -0.50) for depression, all favoring ACT. Subgroup analyses showed that the effects were statistically significant across almost all subgroups and for some outcomes were greater in the trials conducted in people with a specific diagnosis (as compared with those conducted in people with general chronic pain), the trials with waitlist or usual care control, the trials with a greater number of sessions of ACT, and the trials with a longer ACT intervention.

DISCUSSION: ACT is effective and comparable to, if not better than, some other available active treatments for chronic pain.

Discipline Area Score
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Comments from MORE raters

Physician rater

ACT is clearly a viable option for CP, but there is little or no evidence here that it is better than CBT. Substantial limitations of the original trials this review include that none of the trials here were blinded, some effects were exaggerated by using wait-list controls, and all results may be exaggerated by publication bias.

Physician rater

This is not a body of evidence that will impact the choice of treatment to any significant degree.

Physician rater

This is a well carried out systematic review examining the effect of acceptance and commitment therapy in chronic pain. The results suggest that Acceptance & Commitment Therapy is effective in reducing pain and other concomitant adverse factors affecting patients with this condition. The fact that all aspects of the damaging effects of chronic pain are improved is encouraging. There are one or two small misprints and publication errors but these are minor and do not affect the impact of this article.

Physician rater

Patients in general have a difficult time accessing these resources in many chronic pain situations.
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