Patient-friendly summary
If you read nothing else
Bottom line
ACT appears to help with chronic pain across pain acceptance, functioning, and pain intensity, but the included studies had methodological weaknesses that may have overstated the benefits, so more rigorous trials are needed.
Preliminary evidencePublished
Evidence hierarchy
Study participants
Adults with chronic pain
Study Summary
This systematic review evaluated the efficacy of Acceptance and Commitment Therapy (ACT) for managing chronic pain, searching the PubMed and EBSCO databases up to April 2020 and including fifteen trials. The authors report that results favored ACT for pain acceptance, functioning, and pain intensity, with small to large effect sizes; only a few studies assessed quality of life, and about half of those favored ACT. The review also looked at online ACT interventions in light of demands created by the COVID-19 pandemic. The authors conclude the evidence points in favor of ACT but caution that the included studies had methodological limitations that may have overestimated the effects.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Results favored ACT across several outcomes | Across the fifteen included trials, results were in favor of ACT for pain acceptance, functioning, and pain intensity, with effect sizes ranging from small to large. | High |
| Quality-of-life evidence was limited and mixed | Few studies evaluated quality of life, and of those that did, about half reported results favorable to ACT. | Medium |
| Methodological limitations may have overestimated effects | The authors note that the included studies suffered from methodological limitations that may have led to overestimated treatment effects, so robust trials are needed to clarify efficacy and identify which patients benefit most. | High |
| Online ACT delivery considered in context of COVID-19 | The review specifically focused part of its analysis on online ACT interventions, reflecting current demands due to the COVID-19 pandemic. | Medium |
Across the fifteen included trials, results were in favor of ACT for pain acceptance, functioning, and pain intensity, with effect sizes ranging from small to large.
Few studies evaluated quality of life, and of those that did, about half reported results favorable to ACT.
The authors note that the included studies suffered from methodological limitations that may have led to overestimated treatment effects, so robust trials are needed to clarify efficacy and identify which patients benefit most.
The review specifically focused part of its analysis on online ACT interventions, reflecting current demands due to the COVID-19 pandemic.
Strengths
- Systematic search across two databases (PubMed and EBSCO) up to a defined cutoff (April 2020)
- Assessed multiple clinically relevant outcomes (pain acceptance, functioning, pain intensity, quality of life)
- Included a focused analysis of online ACT delivery, relevant to remote-care needs during the COVID-19 pandemic
- Authors transparently acknowledge methodological limitations and the risk of overestimated effects
Limitations
- Included studies suffered from methodological limitations that may have led to overestimated effects
- Few studies evaluated quality of life, limiting conclusions for that outcome
- The total number of participants, specific chronic-pain conditions, and effect-size values are not reported in this abstract
- Published as a conference abstract (EPA Congress supplement), so detailed methods and risk-of-bias assessment are not available
- The authors call for methodologically robust trials and note it is still unclear which patients benefit most
Key Takeaways for Patients
What This Means for You
- 01Acceptance and Commitment Therapy (ACT) is a psychological approach that helps people pursue meaningful, values-based activities even while living with ongoing pain, rather than focusing only on eliminating the pain.
- 02This review of fifteen trials suggests ACT may improve pain acceptance, day-to-day functioning, and pain intensity, though the size of the benefit varied.
- 03ACT can be delivered online, which became especially relevant during the COVID-19 pandemic.
- 04The evidence is encouraging but not definitive — the studies had limitations, so talk with your clinician about whether ACT fits your situation.