Efficacy of ACT in Patients Scheduled for Lumbar Spine Surgery

Objectives: (1) To analyze the effectiveness of adding a group-based form of Acceptance and Commitment Therapy (ACT) to the treatment as usual (TAU) for preoperative patients diagnosed with degenerative lumbar pathology plus psychosocial risk factors related to post-surgical chronic pain at baseline and after psychological treatment. (2) To examine the effectiveness of ACT on the improvement of pain interference, pain-related and behavioral variables in degenerative lumbar pathology preoperative patients after lumbar spine surgery in comparison with TAU. (3) To measure the proximal and distal effects of ACT in preoperative patients with degenerative lumbar pathology who had the surgery after ACT program completion in comparison with proximal and distal TAU surgery effects on pain related variables.Method: A 12-month randomized controlled trial (RCT) will be conducted at Hospital del Mar (Barcelona). Only those preoperative degenerative lumbar pathology patients with psychosocial risk factors for chronic post-surgical pain will be randomized to pre-surgical ACT group or to TAU. Evaluations will be completed before treatment (baseline), after ACT therapy (3 months), a first follow-up (6 months from baseline alias 3 months after surgery), second follow-up (9 months from baseline alias 6 months after surgery), and final follow-up (15 months from baseline alias 12 months from surgery).Participants: 80 adult preoperative patients with degenerative lumbar pathology plus psychosocial risk factors related to post-surgical chronic pain will be randomly assigned to two arms: ACT + TAU vs TAU.Primary outcome: Pain interference. Secondary outcomes: pain intensity, pain catastrophising, pain acceptance, pain disability, kinesiophobia, depression symptoms, anxiety symptoms, psychological flexibility, and quality of life.Main statistical analyses: Intention-to-Treat analyses that will include all participants who undergo random allocation, using multiple imputation to replace missing values. General linear mixed-effects models will be performed using Restricted Maximum Likelihood to estimate the parameters. Calculation of between-groups effect sizes using Cohen's d and of the number-needed-to-treat.

Inclusion Criteria:Age 18- 80 yearsPossess an adequate understanding of Spanish or CatalanMeet the diagnostic criteria for lumbar pain/degenerative lumbar pathology candidates for surgical treatment.Diagnoses:Lumbar canal stenosis.Foraminal stenosis.Lumbar spondylolisthesis.Lumbar degenerative disc disease.Degenerative scoliosis.Lumbar kyphosis.Procedures:Laminectomy. Foraminoplasty. Laminectomy and posterior arthrodesis. previous arthrodesis.Presence of psychosocial risk factors for chronic post-surgical pain:Mild-moderate anxiety/depression symptoms (HADS hospital anxiety and depression sub-scales≥11, see measurement instruments section) and/orPresence of catastrophizing (PCS catastrophizing scale (0-52) ≥24, see measurement instruments section), and/orKinesiophobia base ≥27, see measurement instruments section)Have an internet connection on a mobile phone, tablet, computer, etc. to be able to carry out group psychological therapy online.Give authorization by signing an informed consentExclusion Criteria:Cognitive impairment that in the clinician's judgment prevents you from participating in therapyPresenting chronic pain not related to the diagnosis of low back pain that is a candidate for surgical treatmentNOT present psychosocial risk factors for chronic post-surgical pain (see inclusion criteria: anxiety, catastrophizing, depression, kinesiophobia)Patients in litigation or who are pending legal claims for compensationSevere or decompensated psychiatric disorder (depression, schizophrenia, bipolar disorder, personality disorder) that in the clinician's judgment prevents you from participating in therapySuicidal ideationConsumption of toxic substances in abuse/dependence, except for smokingPatients with a language barrier (Spanish/Catalan)Patients who do not authorize it voluntarily and do not want to participate