Background & Aims
Pain neuroscience education (PNE) combined with exercise has been shown to be an effective treatment in the management of patients with chronic spinal pain (CSP) (1-4). However, no previous review has explored the influence of the different contents included in the PNE. The objective was to evaluate the moderating effect of the different contents and the sum of them on changes in pain intensity and disability in patients with CSP receiving PNE combined with exercise.
Methods
A systematic search of PubMed, Scopus, Embase, Web of Science and CENTRAL was conducted from inception to 19 April 2023. We included randomized controlled trials in people with CSP receiving PNE combined with exercise, with no other co-interventions. Outcome measures included pain intensity and disability. In addition, data on the contents of the PNE were extracted following previous recommendations. In order to identify possible moderators affecting the overall results, a mixed methods moderator analysis was applied.
Results
A total of 11 studies were included. Compliance with the key contents included in the PNE were: Basic neurophysiology and pain physiology (81.8%); Chronic pain physiology and central sensitization (63.6%); Pain neuromatrix (36.7%); Influencing/sustaining factor (54.5%); Multifactorial experience of pain (18.2%); Activity pacing (18.2%); Transfer knowledge about pain to an adaptive behavioral change (63.6%);Reconceptualization of pain (72.7%); Mindfulness/relaxation/breathing exercise (9.1%). The total number of contents included showed a significant effect on pain (z=-2.12, P =0.034, 95% confidence interval [CI] -1.19 to -0.05). In terms of each content, only a significant effect was obtained for ‘transfer knowledge about pain to an adaptive behavioral change’ (z=-2.35, P =0.019, 95% CI -3.42 to -0.31) and ‘reconceptualization of pain’ (z=-2.43, P =0.015, 95% CI -3.70 to -0.39). No significant effect on disability was found.
Conclusions
The number of key contents included in the PNE programs was a moderating variable for changes in pain intensity in patients with CSP. Among the contents explored, a significant interaction was only found for the inclusion of aspects related to the transfer of pain knowledge to adaptive behavioral change and pain reconceptualization. Therefore, clinicians may prioritize the implementation of PNE programs with these characteristics and not focus solely on content related to basic neurophysiology and pain physiology.
References
1. Núñez-Cortés R, Salazar-Méndez J, Calatayud J, Malfliet A, Lluch E, Mendez-Rebolledo G, Guzmán-Muñoz E, López-Bueno R, Suso-Martí L. The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: A systematic review and dose-response meta-analysis. Pain. 2023 Nov 30. doi: 10.1097/j.pain.0000000000003126.
2. Benedict TM, Nitz AJ, Gambrel MK, Louw A. Pain neuroscience education improves post-traumatic stress disorder, disability, and pain self-efficacy in veterans and service members with chronic low back pain: preliminary results from a randomized controlled trial with 12-month follow-up. Mil Psychol 2023:1–17. doi: 10.1080/08995605.2023.2188046.
3. Bodes Pardo G, Lluch Girbés E, Roussel NA, Gallego Izquierdo T, Jiménez Penick V, Pecos Martín D. Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: a single-blind randomized controlled trial. Arch Phys Med Rehabil 2018;99:338–47.
4. Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, Cagnie B, Danneels L, Nijs J. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: a randomized clinical trial. JAMA Neurol 2018;75:808–17.
Presenting Author
Rodrigo Núñez-Cortés
Poster Authors
Rodrigo Núñez-Cortés, PhD, MSc, PT
PT, PhD
University of Chile
Lead Author
Joaquín Salazar-Méndez
PT
Universidad Santo Tomás
Lead Author
Carlos Cruz-Montecinos
PT
University of Chile
Lead Author
Giselle Horment
University of Chile
Lead Author
Enrique Lluch
PT
University of Valencia
Lead Author
Joaquín Calatayud
PhD
University of Valencia
Lead Author
Luis Suso-Martí
PT
University of Valencia
Lead Author
Topics
- Systematic Reviews/Meta-Analysis