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Profiles of Pain Acceptance and Values-Based Action in the Assessment and Treatment of Chronic Pain

  • Eric Kruger
    Correspondence
    Address reprint requests to Eric Kruger, PT, DPT, PhD, Department of Orthopaedics and Rehabilitation, 1 University of New Mexico, MSC09 5230, Albuquerque, NM 87131.
    Affiliations
    Department of Orthopaedics and Rehabilitation, School of Medicine, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
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  • Julie Ashworth
    Affiliations
    Impact Community Pain Service, Midlands Partnership Foundation NHS Trust, Stoke-on-Trent, United Kingdom

    Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Newcastle, United Kingdom
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  • Gail Sowden
    Affiliations
    School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
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  • Jayne Hickman
    Affiliations
    Pain Service, Sandwell and West Birmingham Hospitals Trust, Birmingham, United Kingdom
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  • Kevin E. Vowles
    Affiliations
    School of Psychology, Queen's University Belfast & the Centre for Chronic Pain Rehabilitation, Belfast Health and Social Care Trust Belfast, Belfast, Northern Ireland
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      Highlights

      • Acceptance and values-based action can be used to identify patient sub-groups.
      • Sub-groups were associated with pain, physical and psychosocial functioning.
      • Sub-groups differed in their response to a psychological treatment for pain.
      • Less acceptance and values-based action was related to greater treatment change.

      Abstract

      Pain acceptance and values-based action are relevant to treatment outcomes in those with chronic pain. It is unclear if patterns of responding in these 2 behavioral processes can be used to classify patients into distinct classes at treatment onset and used to predict treatment response. This observational cohort study had 2 distinct goals. First, it sought to classify patients at assessment based on pain acceptance and values-based action (N = 1746). Second, it sought to examine treatment outcomes based on class membership in a sub-set of patients completing an interdisciplinary pain rehabilitation program of Acceptance and Commitment Therapy for chronic pain (N = 343). Latent profile analysis was used in the larger sample to identify 3 distinct patient classes: low acceptance and values-based (AV) action (Low AV; n = 424), moderate acceptance and values-based action (Moderate AV; n = 983) and high acceptance and values-based action (High AV; n = 339). In the smaller treated sample, participants in the Low AV and Moderate AV class demonstrated improvements across all outcome variables, whereas those in the High AV class did not. These findings support the role of pain acceptance and values-based action in those with chronic pain.

      Perspective

      Individuals with chronic pain can be classified with respect to pain acceptance and values-based action and these groups may respond differently to treatment.

      Key words

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