Psychological flexibility in adults with chronic pain: a study of acceptance, mindfulness, and values-based action in primary care.

There is an increasing number of studies of acceptance, mindfulness, and values-based action in relation to chronic pain. Evidence from these studies suggests that these processes may be important for reducing the suffering and disability arising in these conditions. Taken together these processes entail an overarching process referred to as "psychological flexibility." While these processes have been studied in people with chronic pain contacted in specialty treatment centers, they have not yet been investigated in primary care. Thus, participants in this study were 239 adults with chronic pain surveyed in primary care, through contact with their General Practitioners (GPs), in the UK. They completed measures of acceptance of chronic pain, mindfulness, psychological acceptance, values-based action, health status, and GP visits related to pain. Correlation coefficients demonstrated significant relations between the components of psychological flexibility and the measures of health and GP visits. In regression analyses, including both pain intensity and psychological flexibility as potential predictors, psychological flexibility accounted for significant variance, DeltaR(2)=.039-.40 (3.9-40.0%). In these regression equations pain intensity accounted for an average of 9.2% of variance while psychological flexibility accounted for 24.1%. These data suggest that psychological flexibility may reduce the impact of chronic pain in patients with low to moderately complex problems outside of specialty care. Due to a particularly conservative recruitment strategy the overall response rate in this study was low and the generality of these results remains to be established. Copyright 2009 International Association for the Study of Pain. All rights reserved.