Acceptance of pain is an independent predictor of mental well-being in patients with chronic pain: empirical evidence and reappraisal Ilse Viane a, * , Geert Crombez a , Christopher Eccleston b , Carine Poppe c , Jacques Devulder c , Boudewijn Van Houdenhove d , Wilfried De Corte a a Faculty of Psychology and Educational Sciences, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium b Pain Management Unit, University of Bath and the Royal National Hospital for Rheumatic Diseases, NHS Trust, UK c Pain Clinic, Ghent University Hospital, Ghent, Belgium d Pain Clinic, Leuven University Hospital, Leuven, Belgium Received 18 March 2003; received in revised form 19 June 2003; accepted 1 July 2003 Abstract This paper reports upon: (1) the value of acceptance of pain in predicting well-being in patients suffering from chronic pain and (2) the construct validity of acceptance by comparing two questionnaires designed to measure acceptance (the Chronic Pain Acceptance Questionnaire, CPAQ, unpublished doctoral dissertation, University of Nevada, Reno, NV, 1992 and the Illness Cognitions Questionnaire, ICQ, J Consult Clin Psychol 69 (2001) 1026). The results of two independent cross-sectional studies are reported. Study 1 included 120 patients seeking help in tertiary care settings. In Study 2, 66 patients were recruited from a self-support group for fibromyalgia patients and from a pain clinic. Both studies revealed that acceptance of pain predicted mental well-being beyond pain severity and pain catastrophizing, but did not account for physical functioning. In both instruments, it was found that acceptance of pain was strongly related to engagement in normal life activities and the recognition that pain may not change. Acceptance in both instruments was strongly related to a cognitive control over pain. Study 2 further revealed that the correlation between the CPAQ and the ICQ is moderate, indicating that both instruments measured different aspects of acceptance. It is concluded that acceptance of chronic pain is best conceived of as the shift away from pain to non-pain aspects of life, and the shift away from a search for a cure with an acknowledgement that pain may not change. q 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. Keywords: Chronic pain; Acceptance; Cognitive Control 1. Introduction Coping is most often defined as the intentional and effortful attempt to adapt to pain (Tunks and Bellissimo, 1988; Keefe et al., 1992). The focus of much coping research has been on excessive or repetitive behaviour that leads to negative consequences. Indeed, research is often concentrated on unhelpful behaviour that should be reduced rather than on behaviour that should be adopted (Geisser et al., 1999). Recently, Evers et al. (2001) have taken up the invitation to consider a positive psychology of chronic adversity (Gillham and Seligman, 1999) by stressing the role of positive concepts such as acceptance and benefits of adversity. In a study of the everyday understandings of acceptance of chronic pain, Risdon et al. (2003) found eight different accounts of acceptance, but all shared the features of the need to focus away from pain to non-pain aspects of life, the recognition that cure of pain is very unlikely, and the rejection of any suggestion that acceptance is a sign of personal failure. Acceptance as the ‘taking control of pain’ was the most commonly endorsed. Although attempting to control pain may have cultural currency, it has an inconsistent career in explaining adaptation to pain (Leventhal, 1992). For example, Brown et al. (1989) found that active strategies to control pain did not reduce depression. Jensen and Karoly (1991, 1992) found that feelings of control were related to better social functioning and lower distress in patients with mild and moderate pain, but not for high-intensity pain. In addition, attempts at 0304-3959/$20.00 q 2003 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved. doi:10.1016/S0304-3959(03)00291-4 Pain 106 (2003) 65–72 www.elsevier.com/locate/pain * Corresponding author. Tel.: þ 32-9-2649105; fax: þ 32-9-2649149. E-mail address: Ilse.Viane@Ugent.ac.be (I. Viane).