Internet-Delivered Psychological Treatments for Chronic Pain in Adolescents: ACT and Pain Education.
NCT ID: NCT06981312
Last Updated: 2025-05-20
Study Results
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Basic Information
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RECRUITING
NA
150 participants
INTERVENTIONAL
2025-05-31
2027-12-31
Brief Summary
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National guidelines in Sweden recommend cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) for children and adolescents with chronic pain and substantial functional limitations. However, more high-quality randomized controlled trials (RCTs) are needed to strengthen the evidence base for these treatments.
The investigators' clinic has developed and evaluated ACT-based treatments for pediatric chronic pain over the past two decades. The protocol has now been adapted into an internet-delivered version to increase accessibility. In a preliminary feasibility study, the investigators observed promising effects on pain interference, though some usability issues have since been addressed.
The treatment is grounded in the fear-avoidance model, which explains how avoidance of pain-related activities can worsen disability over time. In ACT, such avoidance is seen as driven by unwanted thoughts, emotions, and bodily sensations. The aim of treatment is to help young people relate more flexibly to pain and fear and to move toward personally meaningful goals - a skill referred to as psychological flexibility. Exposure is a core component of ACT, encouraging patients to engage with avoided thoughts, feelings, and activities in order to reduce avoidance and improve functioning.
In addition to treating the young person, the study also targets parental behaviors. Parents often respond to their child's pain by increasing protection and monitoring, which is natural but can sometimes contribute to further avoidance and reduced independence in the child. ACT-based parent support is designed to help caregivers support their child more effectively.
In this randomized trial, internet-delivered ACT will be compared to two control conditions: (1) an active comparator involving online pain education, and (2) a passive control group on a wait list. The pain education intervention is based on Pain Science Education (PSE), which aims to shift how individuals understand their pain - from seeing it as a sign of injury to recognizing it as a false alarm in the nervous system. PSE has shown promising effects in adults, but research in youth is still limited, and no RCTs have yet been published.
The study responds to the need for well-designed digital interventions that reach more young people, evaluate treatment components more clearly, and include comparison groups that also receive digital interventions. The goal of the study is to further improve treatment effects by (1) emphasizing exposure strategies to reduce avoidance, (2) expanding pain education to enhance treatment understanding, and (3) refining parent support to better help families manage chronic pain over the long term.
The project aims to increase knowledge about the effects of psychological treatments - in this case delivered online - for adolescents with chronic pain. As previous studies have highlighted the promise of exposure-based strategies and digital accessibility, the study aims to evaluate the effect of a treatment that combines and optimizes both. The study also aims to better understand the specific impact of pain education as a stand-alone intervention, as this is a growing research field with limited studies in youth. Regarding the parent support component of ACT, the study will evaluate whether changes in parental behaviors related to their child's pain are associated with reduced parenting stress and improved functioning and quality of life in the adolescents. In addition to evaluating treatment outcomes, the study aims to explore the underlying processes that may contribute to the effects of ACT and pain education.
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Detailed Description
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Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Exposure enhanced Acceptance and Commitment Therapy
The treatment protocol to be evaluated focuses on reducing the perceived threat value of pain through pain education, breaking avoidance behaviors through exposure, and increasing the adolescent's psychological flexibility, which are assumed to lead to improvements in function and quality of life. The treatment lasts for nine weeks, during which participants, by accessing information and working with structured exercises, acquire the content of the treatment. The treatment is primarily text-based but also includes images, videos, and audio files. The treatment is provided through the an online platform. Communication with the therapist occurs at least once a week.
Acceptance and Commitment Therapy
Participants receive a 9-week internet-delivered intervention: 2 weeks of Pain Neuroscience Education (PNE) based on the PSE curriculum, followed by 7 weeks of Acceptance and Commitment Therapy (ACT) targeting psychological flexibility. In addition to value-oriented behavioral activation, the ACT content includes classical exposure. The treatment is mainly text-based, supported by multimedia content, and delivered on a secure digital platform. Communication with a clinician occurs at least weekly. Parents receive a parallel program based on PSE, ACT, and behavioral principles to support flexible and effective parenting.
Pain Science Education
This group undergoes the same pain education as the experimental group but with a more comprehensive educational material. The pain education is based on the PSE curriculum. Pain education is relevant as an active control condition, as it is recommended for all patients with at least moderate chronic pain symptoms according to the national care program.
Pain Science Education
Participants receive 9 weeks of internet-delivered Pain Science Education (PSE), based on the PSE curriculum but with more detailed content, including extended examples, reflection exercises, and behavioral experiments. The aim is to reduce the threat value of pain by promoting a reconceptualization of pain. Parents receive a parallel program with tailored content. The intervention is text-based with multimedia components and delivered via a secure platform. Clinician support is provided asynchronously at least once weekly.
Wait list control
Treatment as usual.
No interventions assigned to this group
Interventions
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Acceptance and Commitment Therapy
Participants receive a 9-week internet-delivered intervention: 2 weeks of Pain Neuroscience Education (PNE) based on the PSE curriculum, followed by 7 weeks of Acceptance and Commitment Therapy (ACT) targeting psychological flexibility. In addition to value-oriented behavioral activation, the ACT content includes classical exposure. The treatment is mainly text-based, supported by multimedia content, and delivered on a secure digital platform. Communication with a clinician occurs at least weekly. Parents receive a parallel program based on PSE, ACT, and behavioral principles to support flexible and effective parenting.
Pain Science Education
Participants receive 9 weeks of internet-delivered Pain Science Education (PSE), based on the PSE curriculum but with more detailed content, including extended examples, reflection exercises, and behavioral experiments. The aim is to reduce the threat value of pain by promoting a reconceptualization of pain. Parents receive a parallel program with tailored content. The intervention is text-based with multimedia components and delivered via a secure platform. Clinician support is provided asynchronously at least once weekly.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Have undergone a medical examination regarding their pain condition.
* Are not using pain-relieving medication, or have been stable on such medication for at least 2 months, with no planned medication changes.
* Have not undergone ACT or CBT treatment in the past six months.
* Can read and write in Swedish without difficulty.
* Have access to a smartphone/computer with an internet connection and e-ID.
* Have at least one parent or guardian who is willing and able to participate in parallel parent support treatment.
Exclusion Criteria
* Adolescents currently undergoing ACT or CBT treatment.
* Adolescents who are using pain-relieving medication or have unstable medication regimes.
* Adolescents without access to a smartphone/computer or e-ID.
13 Years
19 Years
ALL
No
Sponsors
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Karolinska Institutet
OTHER
Forskningsrådet för hälsa, arbetsliv och välfärd (FORTE)
UNKNOWN
Region Stockholm
OTHER_GOV
Responsible Party
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Charlotte S Gentili
Principal Investigator
Locations
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Karolinska University Hospital
Vallentuna, , Sweden
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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2024-01359
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
K 2025-3096
Identifier Type: -
Identifier Source: org_study_id
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