Acceptance and commitment therapy (ACT) for pediatric chronic non-cancer pain: A systematic review

Objective: Acceptance and Commitment Therapy (ACT) is an emerging intervention in the paediatric population but is also increasingly being applied across a range of conditions, including chronic noncancer pain (CNCP). The aim of this study was to evaluate the efficacy of ACT in paediatric CNCP. Methods: A systematic review of English and Spanish articles was conducted. The search was performed in July 2023 and updated in September 2024, using Medline, APA PsycInfo, Psychology Database, APA PsycArticles, PubMed, and Web of Science. We included quasi-experimental pre-post studies and randomized controlled trials (RCT) based on ACT treatment for the paediatric population with a diagnosis of CNCP. Data were extracted by two of the authors using predefined data fields. The risk of bias was evaluated using the Study Quality Assessment Tools of the National Heart Lung and Blood Institute. Results: Nine articles met the inclusion criteria (8 pre-post studies and one RCT), involving a total of 423 children and adolescents and 380 parents. The studies assessed variables related to the following areas: physical, psychological, and social/academic. The inclusion of parents in the intervention was taken into account. At a moderate level of evidence, the following variables generally showed a significant change after the intervention: pain interference, anxiety, depression, pain catastrophizing, pain reactivity, and psychological flexibility in the children, adolescents, and their parents. However, overall, the studies had a moderate risk of bias. Conclusions: ACT could be efficacious in the treatment of paediatric CNCP; furthermore, the inclusion of parents could lead to improved outcomes. While these findings are promising, further research is needed.