Elsevier

Behavior Therapy

Volume 38, Issue 4, December 2007, Pages 412-425
Behavior Therapy

Effects of Pain Acceptance and Pain Control Strategies on Physical Impairment in Individuals With Chronic Low Back Pain

https://doi.org/10.1016/j.beth.2007.02.001Get rights and content

Abstract

Psychosocial treatments for chronic pain are effective. There is a need, however, to understand the processes involved in determining how these treatments contribute to behavior change. Control and acceptance strategies represent two potentially important processes involved in treatment, although they differ significantly in approach. Results from laboratory-based studies suggest that acceptance-oriented strategies significantly enhance pain tolerance and behavioral persistence, compared with control-oriented strategies. There is a need, however, to investigate processes of acceptance and control directly in clinical settings. The present study investigated the effects of three brief instructional sets (pain control, pain acceptance, continued practice) on demonstrated physical impairment in 74 individuals with chronic low back pain using an analogue experimental design. After controlling for baseline performance, the pain acceptance group demonstrated greater overall functioning on a set of 7 standardized physical tasks relative to the other two groups, which did not differ from one another. Further, the acceptance group exhibited a 16.3% improvement in impairment, whereas the pain control group worsened by 8.3% and the continued practice group improved by 2.5%. These results suggest that acceptance may be a key process involved in behavior change in individuals with chronic pain.

Section snippets

Participants

There were 91 individuals with persistent low back pain of greater than 3 months duration who consented to participate. Each of these individuals was recruited during treatment evaluation appointments from a multidisciplinary functional restoration treatment center located in the southeastern United States. Participation was voluntary and predicated on the ability to read and walk independently, as well as the presence of a primary complaint of low back pain. In addition, the clinic protocol

Analytic Approach

In total, 26 individuals (35.1%) were assigned to the acceptance group, 23 (31.1%) to the pain control group, and 25 (33.8%) to the continued practice group. There were three steps to the data analytic procedure. First, differences among the groups at baseline were assessed via a series of multivariate and univariate analyses of variance (MANOVAs and ANOVAs, respectively) for continuous variables and chi-square analyses for categorical variables. Second, differences among the patient groups

Discussion

The present study was designed to evaluate the effects of brief pain control and pain acceptance rationales on measures of physical impairment in a sample of patients with chronic low back pain using an analogue experimental design. It was hypothesized that an explicitly control-focused set of instructions would have a lesser effect on patient performance in comparison to a set of instructions asking participants to notice thoughts and feelings in response to the tasks and to behave in a way

References (45)

  • N. Maniadakis et al.

    The economic burden of back pain in the UK

    Pain

    (2000)
  • L.M. McCracken et al.

    Acceptance and change in the context of chronic pain

    Pain

    (2004)
  • L.M. McCracken et al.

    Prediction of pain in patients with chronic low back pain: Effects of inaccurate prediction and pain-related anxiety

    Behaviour Research and Therapy

    (1993)
  • L.M. McCracken et al.

    Acceptance of chronic pain: Component analysis and a revised assessment method

    Pain

    (2004)
  • L.M. McCracken et al.

    Acceptance-based treatment for persons with complex, long standing chronic pain: A preliminary analysis of treatment outcome in comparison to a waiting phase

    Behaviour Research and Therapy

    (2005)
  • R. Melzack

    The short form McGill Questionnaire

    Pain

    (1987)
  • S. Morley et al.

    Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache

    Pain

    (1999)
  • M. Sleed et al.

    The economic impact of chronic pain in adolescence: Methodological considerations and a preliminary costs-of-illness study

    Pain

    (2005)
  • G. Tan et al.

    Measuring control appraisals in chronic pain

    Journal of Pain

    (2002)
  • K.E. Vowles et al.

    Processes of behavior change in interdisciplinary treatment of chronic pain: Contributions of pain intensity, catastrophizing, and acceptance

    European Journal of Pain

    (2007)
  • R.K. Wicksell et al.

    Exposure 1253 and acceptance in the rehabilitation of adolescents with idiopathic chronic pain—A pilot study

    European Journal of Pain

    (2007)
  • P. Bach et al.

    The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial

    Journal of Consulting and Clinical Psychology

    (2002)
  • Cited by (79)

    • Acceptance and commitment therapy for individuals having attention deficit hyperactivity disorder (ADHD): A scoping review

      2021, Heliyon
      Citation Excerpt :

      Adaptations of ACT are performed for persons with anxiety as well as depressive disorders (Bai et al., 2020; Eifert and Forsyth, 2005; Zettle, 2007). In this regard, experimental studies have demonstrated usefulness of ACT for anxiety and depressive disorders (Bai et al., 2020; Bond and Bunce, 2000; Forman et al., 2007; Kelson et al., 2019; Lappalainen et al., 2007; Twohig and Levin, 2017; Zettle and Hayes, 1986), physical health issues (González-Fernández and Fernández-Rodríguez, 2019; Gregg et al., 2007; Taheri et al., 2020; Vowles et al., 2007), other mental health issues (Gaudiano and Herbert, 2006; Gratz and Gunderson, 2006), and neurodevelopmental disorders particularly among children autism spectrum disorders (Byrne et al., 2020; Pahnke et al., 2019). ACT favors a wide and flexible array of behaviors and neutralizing psychological practices speculated to be accountable for much of the individuals’ suffering, and as such may be superior to more traditional behavioral practices.

    View all citing articles on Scopus

    Financial support was provided by the West Virginia University (WVU) Eberly College of Arts and Sciences, the WVU Department of Psychology Alumni Fund, PSIMED, and Oasis Occupational Rehabilitation and Pain Management. Thanks to Dr. Lance McCracken for comments on an earlier draft of this manuscript.

    View full text