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Embrace Pain-A Randomized Controlled Trial of Online Acceptance and Commitment Therapy for Painful
Daniëlle L van de Graaf1,2, Paul Lodder1,3, Tom Smeets1
1Department of Medical and Clinical Psychology, CoRPS-Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands.
Introduction:
Chemotherapy-induced peripheral neuropathy (CIPN) is a common and persistent side effect of chemotherapy, with up to 30% of patients reporting symptoms 6 months post-treatment. Painful CIPN can impair sleep, mood, and physical functioning. We evaluated "Embrace Pain," an online Acceptance and Commitment Therapy (ACT) based self-help intervention that may be of support for cancer survivors with chronic painful CIPN.
Methods:
The Embrace Pain Randomized Controlled Trial (RCT) compared ACT with a waiting list condition (WLC) using a two-armed randomized design. Adults (≥ 18 years) with painful CIPN ≥ 6 months post-chemotherapy were randomized to an 8-week guided online ACT program or WLC. Primary outcome was pain interference (Multidimensional Pain Inventory, MPI). Secondary outcomes included pain catastrophizing, psychological flexibility, CIPN severity, pain intensity, and quality of life (QoL). Linear mixed models and criteria for clinically significant change were used to evaluate outcomes from baseline to 3-month follow-up.
Results:
112 participants were included (57 ACT, 55 WLC). No significant treatment effect was observed for the primary outcome, pain interference, with ACT not outperforming the WLC over time. However, more ACT participants showed clinically significant improvement in pain interference at 3-month follow-up (47.4% vs. 23.6%) than WLC participants, and exploratory analyses showed greater reductions in pain catastrophizing in the ACT group. No between-group differences were found for psychological flexibility, CIPN severity, pain intensity, or QoL.
Discussion:
Online ACT did not demonstrate a significant treatment effect on pain interference in those with painful CIPN. Exploratory findings suggest potential benefits for pain catastrophizing and clinically meaningful improvement in pain interference for some participants. Larger studies are needed to confirm these findings.
