9/2/26
For many people with axial spondyloarthritis (axSpA), pain can continue even when inflammation is being treated. A recent study explored whether a digital behavioral therapy program could help people better manage the impact of persistent pain on their daily lives.
Researchers studied 136 people with axSpA who continued to experience pain despite being on stable medication. Participants were randomly assigned to either continue their usual care or receive access to a digital health app in addition to their usual care.
The app used acceptance and commitment therapy (ACT), a form of behavioral therapy that teaches strategies for responding to difficult thoughts, emotions, and physical symptoms. Rather than trying to eliminate pain, ACT focuses on helping people develop skills to cope with symptoms and continue participating in activities that are meaningful to them.
What Did the Study Find?
After 12 weeks, people assigned to the digital therapy group showed greater improvement in how much pain interfered with their lives compared with those receiving usual care alone. They also showed improvement in emotional distress related to their disease.
Researchers looked at several other measures as well. Improvements were seen in areas including physical function, overall health, disease activity, and measures related to pain, particularly among participants who actively used the app.
The study also found reductions in the percentage of participants reporting clinically relevant symptoms of depression and anxiety in the digital therapy group.
However, not everyone assigned to the digital program used it. Of the 73 participants who received access to the app, 44 actively used it, and only 19 completed all of the program’s lessons. Some participants chose not to use the app, while others were unable to access it because they did not receive an activation code from their health insurance provider.
What Does This Mean for People with AxSpA?
The findings add to growing research suggesting that managing persistent pain in axSpA may require more than controlling inflammation alone.
For some people, pain can continue even when inflammatory disease activity is being treated. Behavioral approaches such as ACT may offer another tool for addressing how persistent pain affects mood, function, and everyday life.
Importantly, behavioral therapy does not suggest that pain is psychological or “all in your head.” AxSpA is an inflammatory disease, and appropriate medical treatment remains essential. Instead, approaches like ACT are designed to help people develop additional strategies for living with symptoms that may persist despite treatment.
The researchers concluded that digital behavioral therapy could potentially serve as a complementary approach to pain management in axSpA. However, the study was relatively small and lasted only 12 weeks. In addition, not everyone assigned to the intervention actually used the app, and fewer than half of active users completed the entire program. More research is needed to determine how effective these approaches are over the long term and how to help more people engage with them.
About the Study
The randomized controlled trial included 136 people with axSpA experiencing persistent pain despite stable medication. Seventy-three participants were assigned to receive the digital ACT program in addition to their usual care, while 63 continued with usual care alone.
Researchers primarily measured changes in pain-related life interference, or how much pain affected participants’ ability to function and participate in everyday life. They also examined pain severity, emotional distress, disease activity, physical function, overall health, and other patient-reported outcomes over 12 weeks.
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