We thank Dr. Wörz for pointing out, as already mentioned in our article (1), that a multimodal and interdisciplinary approach is the gold standard in the treatment of chronic pain. At the same time, this type of care is inaccessible to the majority of those affected, and pharmacological monotherapy is in line with our reality of care (2). Against this background, it also appears ethically imperative to exhaust all treatment options and to promote the development, evaluation, and, if proven effective, integration of online interventions into our health care system (3).
A „stand-alone“ treatment, such as ACTonPain, offers many possibilities to move towards the multimodal treatment, for example through:
- the option of a general practitioner or specialist being able to prescribe an online pain intervention;
- the involvement of such interventions in disease management programs;
- the integration of online and offline offers (3).
A prerequisite for this is the proof-of-efficacy, which has now been shown for ACTonPain, for the first time in Germany (1).
To implement ACTonPain in routine care, which is the next logical step, the multitude of integration options should be exhausted and the respective variants to be implemented should be scientifically evaluated.
With regard to a wide range of applications and high scalability, an advantage of ACTonPain is that it presents a generic pain intervention with a wide range of application areas.
Psychological interventions focus on altering cognitive, emotional, and behavioral mechanisms for dealing with chronic pain and therefore often adopt a wide-range of area, generic approach (4). We thus agree with Dr. Wörz that treatment of chronic pain should be based on a biopsychosocial assessment at initial diagnosis as well during further diagnostic work-up (3).
On behalf of the authors
Dr. phil. Jiaxi Lin, M.Sc. Psych.
King’s College London, Health Psychology Section,
Psychology Department, Institute of Psychiatry,
Psychology & Neuroscience (IoPPN), London, UK
Prof. Dr. phil. Harald Baumeister, Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education Science, University of Ulm, German
Conflict of interest statement
Dr. Lin, M.Sc. Psych, and Prof. Baumeister are (co-)authors and co-developers of ACTonPain.
Prof. Baumeister has received a consulting honorarium from the German Chamber of Psychotherapists (Bundespsychotherapeutenkammer); reimbursement of conference fees and travel expenses as well as speaking honoraria from the German Chamber of Psychotherapists, the Regional Chamber of Psychotherapists of Baden-Württemberg (Landespsychotherapeutenkammer Baden-Württemberg), and the Dachverband für Gemeindepsychiatrie; study support (third-party funds) from BARMER GEK, the SVLFG, and the Deutschen Rentenversicherung (the German Statutory Pension Insurance Scheme); honoraria for speaking about the topic “Online-based psychotherapy” from the Freiburger Ausbildungsinstitut für Verhaltenstherapie (FAVT GmbH).
|1.||Lin J, Paganini S, Sander L, Lüking M, Ebert DD, Buhrman M, Andersson G, Baumeister H: An Internet-based intervention for chronic pain—a three-arm randomized controlled study of the effectiveness of guided and unguided acceptance and commitment therapy. Dtsch Arztebl Int 2017; 114: 681–8 VOLLTEXT|
|2.||Dietl M, Korczak D: Versorgungssituation in der Schmerztherapie in Deutschland im internationalen Vergleich hinsichtlich Über-, Unter-oder Fehlversorgung: HTA-Bericht. Deutsches Institut für medizinische Dokumentation und Information (DIMDI) (eds.). Schriftenreihe Health Technology Assessment (HTA) 2011; Band: 111.|
|3.||Baumeister H, Lin J, Ebert DD: Internet- und mobilebasierte Ansätze: Psychosoziale Diagnostik und Behandlung in der medizinischen Rehabilitation. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2017; 60: 436–44 CrossRef MEDLINE|
|4.||Williams A, Eccleston C, Morley S: Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2012; 11: 1–83 CrossRef|