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Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
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Operant Approach Activity Pacing Interventions for the Management of Chronic Pain: A Systematic Review.
Deborah Antcliff1,2, Laura Burns3, Eleanor English4
1Bury Integrated Pain Service, Northern Care Alliance NHS Foundation Trust, Radcliffe Primary Care Centre, Greater Manchester, UK, M26 2SP.
The Clinical Journal of Pain
|May 5, 2026
Summary
Activity pacing interventions for chronic pain show mixed results for pain and fatigue, though some improvements in function are noted. Further research is needed to develop and test standardized operant approach activity pacing.
Area of Science:
- Pain Management
- Rehabilitation Science
- Behavioral Medicine
Background:
- Operant approach activity pacing, which involves undertaking activities based on quotas rather than symptom severity, is recommended for chronic pain management.
- A standardized intervention addressing all components of operant approach activity pacing is currently lacking.
- This systematic review addresses the need to identify and explore existing operant approach activity pacing interventions for chronic pain.
Purpose of the Study:
- To systematically identify operant approach activity pacing interventions for chronic pain.
- To explore the components, effectiveness, feasibility, and acceptability of these interventions.
- To inform the development of more effective activity pacing strategies for individuals with chronic pain.
Main Methods:
- A systematic review of studies evaluating operant approach activity pacing interventions in adults with chronic pain.
- Included studies of any evaluation type (RCTs, feasibility, qualitative) published in English.
- Excluded interventions based on energy conservation, envelope theory, adaptive pacing therapy, or symptom-contingency. Data synthesis was narrative, with risk of bias and confidence in evidence assessed.
Main Results:
- Nine studies involving 873 participants and 10 distinct interventions were included.
- Interventions varied in content, duration (2-11 sessions), and tailoring to individual needs.
- Common components included pre-planning, activity-rest cycles, and alternating activities/positions, with a trend towards improved function but mixed results for pain and fatigue.
Conclusions:
- Current evidence on the effectiveness of operant approach activity pacing for chronic pain is limited and of very low confidence.
- The heterogeneity of interventions and outcome measures restricts definitive conclusions.
- Further development and rigorous testing of standardized operant activity pacing interventions are necessary to improve outcomes for chronic pain patients.
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