Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis

Veehof, Martine M.^a,*; Oskam, Maarten-Jan^a; Schreurs, Karlein M.G.^a,b; Bohlmeijer, Ernst T.^a

^aUniversity of Twente, Enschede, The Netherlands

^bRoessingh Rehabilitation Centre, Enschede, The Netherlands

^*Corresponding author. Address: University of Twente, Department of Psychology and Communication of Health and Risk, Citadel, Room 402, Postbus 217, 7500 AE Enschede, The Netherlands. Tel.: +31 53 489 6071; fax: +31 53 489 2388.

E-mail:[email protected]

Submitted August 31, 2009; revised August 23, 2010; accepted November 2, 2010.

Pain152(3):p 533-542, March 2011. |DOI:10.1016/j.pain.2010.11.002

Abstract

Acceptance-based interventions such as mindfulness-based stress reduction program and acceptance and commitment therapy are alternative therapies for cognitive behavioral therapy for treating chronic pain patients. To assess the effects of acceptance-based interventions on patients with chronic pain, we conducted a systematic review and meta-analysis of controlled and noncontrolled studies reporting effects on mental and physical health of pain patients. All studies were rated for quality. Primary outcome measures were pain intensity and depression. Secondary outcomes were anxiety, physical wellbeing, and quality of life. Twenty-two studies (9 randomized controlled studies, 5 clinical controlled studies [without randomization] and 8 noncontrolled studies) were included, totaling 1235 patients with chronic pain. An effect size on pain of 0.37 was found for the controlled studies. The effect on depression was 0.32. The quality of the studies was not found to moderate the effects of acceptance-based interventions. The results suggest that at present mindfulness-based stress reduction program and acceptance and commitment therapy are not superior to cognitive behavioral therapy but can be good alternatives. More high-quality studies are needed. It is recommended to focus on therapies that integrate mindfulness and behavioral therapy.

Acceptance-based therapies have small to medium effects on physical and mental health in chronic pain patients. These effects are comparable to those of cognitive behavioral therapy.