{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T12:18:47Z","timestamp":1779365927359,"version":"3.53.0"},"reference-count":52,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This randomized controlled trial evaluated the effectiveness of group\u2010based online Acceptance and Commitment Therapy (ACT) compared with treatment as usual (TAU) in improving postsurgical outcomes in patients with degenerative lumbar conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 91 participants scheduled for lumbar surgery were randomly assigned to either ACT or TAU, with primary analyses conducted in a modified intention\u2010to\u2010treat sample of participants who underwent surgery (\n                      <jats:italic>n<\/jats:italic>\n                      =\u200954). Outcomes and process variables were assessed at baseline, post\u2010treatment (pre\u2010surgery), and at 3\u2010, 6\u2010 and 12\u2010month post\u2010surgery follow\u2010up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Linear mixed model analysis showed that ACT (vs. TAU) produced larger reductions in pain interference (primary outcome) at post\u2010treatment (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.86) and at 3\u2010month (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.82), 6\u2010month (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.49) and 12\u2010month post\u2010surgery follow\u2010up (\n                      <jats:italic>d<\/jats:italic>\n                      = \u22121.68). ACT yielded greater improvements than TAU in secondary outcomes, including depressive\/anxiety symptoms (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.69\u20131.99), pain catastrophizing (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20090.84\u20130.97), kinesiophobia (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20090.76\u20130.92) and low back pain\u2010related disability (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.39\u20131.91); and process variables, including psychological flexibility (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20091.71\u20132.44) and pain acceptance (\n                      <jats:italic>d<\/jats:italic>\n                      =\u20092.33\u20133.04). Across time, no significant between\u2010group differences in pain severity were observed. No indirect effects of ACT (vs. TAU) on outcomes through process variables were found. Clinically relevant number needed to treat values for pain interference response were obtained at 3\u2010month (NNT\u2009=\u20094), 6\u2010month (NNT\u2009=\u20092) and 12\u2010month (NNT\u2009=\u20094) post\u2010surgery follow\u2010ups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, these findings support the importance of delivering ACT before surgery to improve pain\u2010related outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance Statement<\/jats:title>\n                    <jats:p>This randomized controlled trial provides evidence that preoperative group\u2010based Acceptance and Commitment Therapy (ACT) improves pain\u2010related outcomes following lumbar surgery. ACT produced reductions in pain interference, depressive\/anxiety symptoms, pain catastrophizing, kinesiophobia, low back pain\u2010related disability, psychological flexibility and pain acceptance, with clinically meaningful numbers needed to treat. These findings extend existing evidence by demonstrating the effectiveness of ACT delivered before surgery and support the integration of perioperative psychological interventions into routine surgical care for patients with degenerative lumbar conditions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejp.70293","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T09:28:50Z","timestamp":1778491730000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of Acceptance and Commitment Therapy (\n                    <scp>ACT<\/scp>\n                    ) for the Management of Postsurgical Pain: A Randomized Controlled Trial (\n                    <scp>SPINE<\/scp>\n                    \u2010\n                    <scp>ACT<\/scp>\n                    Study)"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6571-503X","authenticated-orcid":false,"given":"Juan R.","family":"Casta\u00f1o\u2010Asins","sequence":"first","affiliation":[{"name":"Department of Psychiatry, ISM Hospital del Mar  Barcelona Spain"},{"name":"Department of Psychiatry and Forensic Medicine Autonomous University of Barcelona  Cerdanyola del Valles Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1688-435X","authenticated-orcid":false,"given":"Juan P.","family":"Sanabria\u2010Mazo","sequence":"additional","affiliation":[{"name":"Unit for the Study and Treatment of Pain\u2014ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC) Universitat Rovira i Virgili  Tarragona Spain"},{"name":"Institut D'investigaci\u00f3 Sanit\u00e0ria Pere Virgili Universitat Rovira i Virgili  Tarragona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9482-4822","authenticated-orcid":false,"given":"Jaime","family":"Navarrete","sequence":"additional","affiliation":[{"name":"Teaching, Research &amp; Innovation Unit, Parc Sanitari Sant Joan de D\u00e9u  St. Boi de Llobregat Spain"},{"name":"Centre of Biomedical Research in Epidemiology and Public Health (CIBERESP)  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Mart\u00edn\u2010L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, ISM Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Vila\u2010Canet","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5274-2124","authenticated-orcid":false,"given":"Anna","family":"Isart\u2010Torruella","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0492-4628","authenticated-orcid":false,"given":"Alejandro","family":"Del Arco\u2010Churruca","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jes\u00fas","family":"Lafuente\u2010Baraza","sequence":"additional","affiliation":[{"name":"Spinal Surgery Unit Hospital del Mar  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6861-7678","authenticated-orcid":false,"given":"Gemma","family":"Parramon\u2010Puig","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Forensic Medicine Autonomous University of Barcelona  Cerdanyola del Valles Spain"},{"name":"Department of Mental Health Hospital Universitari Vall D'hebron  Barcelona Spain"},{"name":"Group of Psychiatry, Mental Health and Addictions Vall D'hebron Research Institute (VHIR)  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0779-6545","authenticated-orcid":false,"given":"Francina","family":"Fonseca\u2010Casals","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, ISM Hospital del Mar  Barcelona Spain"},{"name":"Hospital del Mar Research Institute  Barcelona Spain"},{"name":"Medicine and Life Sciences Department Niversitat Pompeu Fabra  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0750-1599","authenticated-orcid":false,"given":"Juan V.","family":"Luciano","sequence":"additional","affiliation":[{"name":"Teaching, Research &amp; 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