Age differences in acceptance and commitment therapy for chronic pain

Abstract

Objective

Chronic pain is prevalent and debilitating, especially among older adults. Acceptance and commitment therapy (ACT) is an evidence-based treatment for chronic pain that, in a prior study, has shown greater benefit among older adults. Critical questions remain regarding the time course and extent of age differences in ACT for chronic pain. The current study sought to inform clinical decision-making by addressing these remaining questions.

Methods

This study reanalyzed data from a prior trial of ACT for chronic pain in US Veterans. We estimated piecewise latent curve models to capture the time course of change in pain intensity, pain interference, pain acceptance, and depression during and after ACT. Then, we examined age as a moderator of longitudinal effects and used pick-a-point models to generate age-specific trajectory predictions.

Results

Older age was associated with significantly greater improvement in pain intensity (p = .003) and marginally greater improvement in pain interference (p = .078) at posttreatment. However, during the six-month follow-up period, older adults relapsed on these outcomes (ps ≤ .029), whereas younger adults maintained their gains or even continued to improve. Older age was only marginally associated with greater depression improvement during the intervention (p = .069), and other moderation effects on depression and pain acceptance were nonsignificant.

Conclusion

Older adults may experience greater initial improvement than younger adults during ACT for chronic pain. However, older adults may then need adjunctive maintenance treatment. Future studies are needed to characterize the mechanisms driving this moderation effect.