Pain-related acceptance and physical impairment in individuals with chronic pain

Treatments using acceptance-based approaches have been utilized for a variety of health care concerns with data regarding their application to a chronic pain population recently emerging. These approaches may be particularly suited to chronic pain as they target potentially harmful avoidance and ineffective pain control strategies. Acceptance of chronic pain is related to psychosocial constructs generally (e.g., depression, pain-related anxiety); however, its relation to the overt behavioral variables associated with such states remains unevaluated. The present investigation assessed the specific effects of an acceptance-based versus control-based instructional set on demonstrated physical impairment in 74 individuals with chronic low back pain. Participants completed a baseline evaluation of physical impairment and then listened to audiotaped instructions detailing one of three approaches (pain acceptance, pain control, and no change). They then repeated the physical impairment assessment and were asked to utilize the approach detailed in the audiotaped instructions to guide behavior during the tasks. Results indicated that, after controlling for baseline levels of physical impairment, individuals receiving the acceptance instructions were less physically impaired at the second assessment compared to the other two groups, which did not differ from one another. Further, individuals in the acceptance group exhibited a 16.3% improvement in impairment level, while the pain control group worsened by 8.3% and the no change group worsened by 2.5%; these changes were also statistically different from one another. Group membership was generally unrelated to pain reported during the physical impairment assessment, a finding theoretically consistent with acceptance models. These results lend further support to the value of acceptance in actual patient behavior, as well as the ability of a relatively simple acceptance-based intervention to improve functioning over the short term in a sample of individuals with chronic pain. Additionally, the findings highlight some of the possible risks in focusing solely on pain control and avoidance, as this method was associated with poorer physical performance compared with the acceptance group. Although the present study was analogue in nature, and thus its findings cannot be directly attributable to clinical realms, it does provide some initial support for these types of approaches within chronic pain