JMIR Publications

ABSTRACT

Background:

Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47 – 56%) and a 40% greater rate of severe pain than non-veterans. This is often accompanied by negative functional outcomes such as decreased work productivity, less familial social support and closeness, increased chronic health conditions (e.g., cancer, heart disease), and higher mortality compared to veterans without chronic pain. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for non-medical pain self-management programs. An interactive, mobile platform to deliver an efficacious treatment for chronic pain such as Acceptance and Commitment Therapy (ACT) could be this option and assist veterans with pain care at home.

Objective:

The purpose of this study was to evaluate the virtual coach-guided Veteran ACT for Chronic Pain online program (VACT-CP) compared to a waitlist and treatment as usual control group (WL+TAU) through a small pilot feasibility RCT. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, including ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and post-test outcome measures for pain, mental health, functioning, and ACT processes.

Methods:

Veterans with chronic pain (n=42) were recruited and randomized to either the VACT-CP or WL+TAU condition. Self-report surveys were administered to participants at baseline (Week 0), the intervention midpoint (Week 3), immediately after the intervention (Week 7: primary outcome time point), and at 1-month follow-up (Week 11). To explore outcome data, non-parametric analyses were used on the intention-to-treat sample.

Results:

Evaluation of study procedures showed good feasibility related to recruitment, enrollment, randomization, and completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale Mean=79.6, SD=12.8, Median = 82.5), completing an average of five of the seven total VACT-CP modules with high post-use satisfaction rates. Qualitative feedback suggested a positive response to program usability, content, tailoring, veteran-centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes, participants the VACT-CP group experienced significant increases in chronic pain acceptance (specifically activity engagement) and decreases in depressive symptoms.

Conclusions:

VACT-CP showed high feasibility, usability, and acceptance, while also providing initial promising results in improving a key process in ACT for chronic pain —notably chronic pain acceptance — after engaging with the online program. These results suggest the potential for VACT-CP to provide an accessible, acceptable, and useful at-home chronic pain management program, and a larger trial is now needed. Clinical Trial: This pilot trial was registered on ClinicalTrials.gov as NCT03655132.