Acceptance and Commitment Therapy for Prevention of Chronic Post-surgical Pain and Opioid Use in At-Risk Veterans: A Pilot Randomized Controlled Study

摘要

High levels of pain, significant anxiety, and/or depressive symptoms prior to surgery put patients at elevated risk forchronic pain and prolonged opioid use following surgery. The purpose of this preliminary study was to assess the efficacy of a one-day Acceptance and Commitment Therapy (ACT) workshop in “at-risk” Veterans for the prevention of chronic pain and opioid use following orthopedic surgery. In a randomized controlled trial, 88 at-risk Veterans undergoing orthopedic surgery were assigned to Treatment as Usual (TAU; N =44) or TAU plus a 1-day ACT workshop (N = 44). Pain levels and opioid use were assessed up to 3 months following surgery. Pain acceptance and values-based behavior were assessed at baseline and 3-month follow-up. Participants who completed the ACT workshop reached pain and opioid cessation sooner than those in TAU. Post-operative complications exhibited a moderating effect on these outcomes such that the effects of ACT were greater in patients without complications. Increases in pain acceptance and values-based behavior, processes targeted in ACT, were related to better outcomes. These promising results merit further investigation in a larger clinical trial. Providing an intervention prior to surgery for at-risk veterans has the potential to change clinical practice from a focus on management of postoperative pain to prevention of chronic pain in at-risk individuals. This study is registered at no.01364870.