Chronic pain is a serious concern that disproportionately affects Veterans compared to
the general public; Veterans are diagnosed with CP at particularly high rates (47 - 56%)
with a 40% greater rate of severe pain than non-Veterans. Veterans with chronic pain face
numerous negative functional outcomes, including decreased ability to complete daily work
activities, less social support from and closeness with family members, increased chronic
health conditions (e.g., cancer, heart disease), and higher mortality compared to
Veterans without chronic pain. Unfortunately, the use of medication for long-term pain
treatment, though often utilized, has both limited efficacy and potentially harmful
outcomes. Given these concerns, there is an urgent need for innovative and integrative
approaches for non-medical pain self-management management. Despite the critical
importance of effective pain self-management programs, many Veterans with chronic pain do
not engage in pain self-management programs available through the VA. There are numerous
reasons for this, including perceived time and transportation concerns and pain-related
barriers to attending in-person care options. To improve Veterans' quality of life and it
is important to develop and evaluate innovative, accessible, evidence-based interventions
for managing pain that can be easily accessed where healthcare happens most - within the
home.
One approach with over twenty years of efficacious treatment for chronic pain is
Acceptance and Commitment Therapy for Chronic Pain (ACT-CP). ACT is a well-established
and VA-approved approach to chronic pain management, and focuses on committing to
behavior change that reflects personal values, leading to significant improvement in life
functioning. Though provided at many VA hospitals, clinician-delivered ACT for chronic
pain has not had a nationwide rollout and is not available at all VA pain clinics.
Additionally, many Veterans with chronic pain do not access one-on-one therapeutic
treatment due to transportation and time issues. Thankfully, for adults with chronic pain
outside of the VA, technology-delivered ACT has been found to be acceptable, useful, and
efficacious in delivering pain treatment. However, although research suggests it could
help with at-home pain management, no ACT for chronic pain online treatment exists
specifically for Veterans and their particular care needs.
To address this treatment option gap, the research team created an online Veteran ACT for
chronic pain (VACT-CP) during the PI's Rehabilitation R&D CDA-2 project. VACT-CP is
guided by an interactive virtual coach (Coach Anne) to help address pain-related distress
and functional difficulties of chronic pain (e.g., avoidance, reactivity) over seven
weeks of treatment. Preliminary findings suggest that VACT-CP is highly usable, perceived
as helpful, and can help Veterans increase their pain acceptance and pain management. The
primary outcomes for this project will be to complete a three-site, fully-powered
efficacy trial comparing VACT-CP to an active online control condition (total n = 200) to
investigate whether VACT-CP can improve pain-related functioning and quality of life. In
addition, the investigators will analyze data from the VACT-CP group to assess whether
the hypothesized mechanism of change (psychological flexibility) mediates the impact of
pain severity on pain-related functioning.