title: Are reductions in pain intensity and pain-related distress necessary? An analysis of within-treatment change trajectories in relation to improved functioning following interdisciplinary acceptance and commitment therapy for adults with chronic pain.
abstract: OBJECTIVE
  A key issue in chronic pain treatment concerns the changes necessary for improved physical and emotional functioning. Traditionally, reducing pain intensity and pain-related distress have been viewed as a prerequisite for these improvements. Alternatively, acceptance and commitment therapy, a behavior change approach, theorizes that pain and distress reduction are not necessary for improvement, rather responses must change, such that functioning improves in clearly specified areas (e.g., engagement in valued activities, decreased disability in social activity) even when pain and distress persist.
  
  
  METHODS
  This study sought to directly examine aspects of change in pain and distress over the course of an interdisciplinary program of acceptance and commitment therapy in relation to functioning at treatment's conclusion and a 3-month follow-up in 174 treated patients. Latent change trajectories of pain intensity and pain-related distress were assessed weekly over 4 weeks of treatment and analyzed via latent growth curve and growth mixture modeling.
  
  
  RESULTS
  A single latent trajectory with a decreasing quadratic slope was indicated for pain, while 2 separate trajectories were identified for pain-related distress 1 of linear decrease and the other an early increase followed by a decrease to initial level. Overall, and with only 3 exceptions across multiple tests, results indicated that trajectories of pain and distress during treatment were not significantly associated with improvements in functioning at treatment's conclusion and follow-up.
  
  
  CONCLUSIONS
  This pattern of findings suggests that significant improvements in functioning may not require decreases in pain intensity and pain-related distress during treatment for chronic pain. (PsycINFO Database Record
authors.affiliation: Department of Psychology.
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Vowles
authors.affiliation: Department of Psychology.
authors.forename: Katie
authors.initials: K
authors.lastname: Witkiewitz
authors.affiliation: IMPACT Pain Service, National Health Service.
authors.forename: Jayne
authors.initials: J
authors.lastname: Levell
authors.affiliation: IMPACT Pain Service, National Health Service.
authors.forename: Gail
authors.initials: G
authors.lastname: Sowden
authors.affiliation: IMPACT Pain Service, National Health Service.
authors.forename: Julie
authors.initials: J
authors.lastname: Ashworth
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000203:Activities of Daily Living; D059350:Chronic Pain / Q000150:complications* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome