An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic.

Abstract

In response to COVID-19, virtual, group-based interdisciplinary pain management programmes (PMPs) were rapidly implemented. This included implementing different intensities and formats of virtual PMPs to address a range of patient needs and complexity. This observational study investigated outcomes associated with virtual high and low intensity and pre-neuromodulation PMPs based on Acceptance and Commitment Therapy (ACT) as part of routine care during the pandemic. Depending on patients' needs, participants completed a virtual high- or low-intensity PMP, or a virtual PMP in preparation for neuromodulation, from June 2020 to June 2022. Participants completed standardized measures of pain intensity and interference, work and social adjustment, depression, and pain acceptance before and after treatment. Data from 2018 and 2019 for in-person residential (n=561), outpatient (n=123), and pre-neuromodulation (n=207) PMPs were also examined to provide an historical benchmark of performance. The virtual high-intensity PMP (n=294) showed significant improvements on all variables, with small effects. There were significant improvements with small effects for pain interference, depression, and acceptance for the virtual pre-neuromodulation PMP (n=129). No statistically significant improvements were observed for the virtual low intensity PMP (n=90). The improvements associated with pre-pandemic in-person PMPs were generally larger relative to the virtual PMPs of comparable intensity delivered during the pandemic. These data provide preliminary support for the potential benefits of high, but not low, intensity virtual ACT-based PMPs, including in the context of neuromodulation. Research is needed to maximize the impact of virtual PMPs and match patients with the most appropriate delivery format.