Assessing Outcomes of Acceptance and Commitment Therapy for Chronic Pain

Neuropsychological performance may not be associated with the improvements in pain interference observed after an 8-week Acceptance and Commitment Therapy (ACT) program in veterans with chronic pain, according to a study published in the Journal of Pain.

This study included 122 veterans with chronic pain who had received care from Veterans Affairs clinics between 2010 and 2013. Study participants had pain on most days (>3 days per week) for ≥6 months and average scores for pain interference and severity of >4 on the 0 to 10 Brief Pain Inventory scale over the past week.

Investigators conducted neuropsychological performance testing, a medical evaluation, and a psychiatric diagnostic interview at baseline.

Neuropsychological performance testing consisted of an evaluation of executive functions (with the inhibition subtest of the Delis-Kaplan Executive Function System Color-Word Interference Test), working memory (assessed with the Wechsler Adult Intelligence Scale [WAIS]Letter-Number Sequencing test), verbal and learning memory (evaluated with the California Verbal Learning Test-II), and processing speed (assessed with the WAIS-IV Symbol Search test). After baseline assessment, participants were randomly assigned to receive an 8-week in-person or video-teleconference ACT program.

Participants taking antidepressants were more likely to have lower Letter-Number Sequencing scores (P =.01). High inhibition scores (indicating high executive function) were associated with reduced pain-related anxiety, depression, pain severity, and pain interference (P <.05 for all).

Also, higher symbol search scores (indicating better processing speed) were associated with reduced pain severity, depression, pain-related anxiety, pain interference, and improved mental and physical health-related quality of life (P <.05 for all). In addition, higher learning scores were associated with lower pain-related anxiety (P <.05) and higher letter-number sequencing scores were associated with lower pain-related anxiety, pain severity and pain interference, and improved mental and physical health-related quality of life (P <.05 for all).

“Neuropsychological performance functioning may not be an important screening tool when considering the suitability of ACT for a chronic pain patient,” concluded the study authors.

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Reference

Herbert MS, Afari N, Robinson JB, et al. Neuropsychological functioning and treatment outcomes in acceptance and commitment therapy for chronic pain [published online March 2, 2018]. J Pain. doi:10.1016/j.jpain.2018.02.008