Background & Aims
Evidence indicates factors ranging from peripheral tissue level changes to altered cognitive processes are involved in the chronicity of pain experience and accordingly treatment guidelines recommend multi-modal strategies to improve pain outcomes. Pain neuroscience education (PNE) is a treatment approach that involves teaching about the neurobiology of pain and has been shown to have promising results on the clinical outcomes in various chronic pain conditions. However, the factors (i.e., mediators and moderators) that influence the effectiveness of PNE are not known. Briefly, a mediator is causal variable between the treatment and outcome, whereas a moderator influences the relationship between treatment and outcomes. Knowledge of such factors would help improve prescription of PNE in the clinical settings. Therefore, we conducted a scoping review to summarize the extent of research on moderators and mediators for the effectiveness of PNE for individuals with chronic pain.
Methods
Given the exploratory nature of our objective to summarize the extent of literature on moderators and mediators for the effectiveness of PNE we considered the scoping review methodology would be appropriate. This scoping review followed the Arksey and O’ Malley framework and the literature search was conducted from inception until December 2023 in the databases: Medline (PubMed), Embase, CINHAL, Pedro, and Cochrane. Studies that reported the moderators and mediators for the effectiveness of PNE were considered for inclusion. The type of study designs included randomized controlled trials, non-randomized trials, secondary analyses, and pre-post studies. Studies not published in English language and conference proceedings were excluded. Two authors screened the retrieved articles for eligibility and a qualitative summary of extracted data (i.e., study characteristics, moderators, mediators, summary measures) was reported.
Results
We identified 2245 potentially eligible tittle and abstracts for screening after the removing duplicates, of which 76 full texts were reviewed for eligibility and seven studies were included in the final review. The most common reason for exclusion is that the studies haven’t investigated or reported on the factors that influenced the effectiveness of PNE. Six studies conducted secondary analysis of randomized controlled trials and one study used clinical audit data to report the variables of interest. Among the examined variables variables participant’s sex, preoperative pain measures, catastrophizing, psychological distress, and kinesiophobia were reported as significant moderators for the effectiveness of PNE, whereas signs of central sensitization and education level did not have a significant effect. No potential mediators for the effectiveness of PNE were reported.
Conclusions
Our review identified variables such as kinesiophobia and pain catastrophizing that may moderate the effectiveness of PNE in chronic pain. These variables need to be further examined in large scale randomized controlled trials of adequate sample. In addition, future research might need to examine the potential mediators that explain the causal mechanisms for the effectiveness of PNE. The results of our review would help guide clinicians in the optimal delivery of PNE and factors to be considered when predicting outcomes following PNE in chronic pain.
References
Cagnie B, Van Looveren E, Malfliet A. Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial. Musculoskelet Sci Pract. 2022 Feb;57:102494.
Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, Nijs J. Patients With Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled Multicenter Trial. PM R. 2018 Dec;10(12)
Huysmans E, Baeyens JP, Dueñas L, Falla D, Meeus M, Roose E, Nijs J, Lluch Girbés E. Do Sex and Pain Characteristics Influence the Effectiveness of Pain Neuroscience Education in People Scheduled for Total Knee Arthroplasty? Secondary Analysis of a Randomized Controlled Trial. Phys Ther. 2021 Dec 1;101(12):pzab197.
Van Bogaert W, Coppieters I, Kregel J, Nijs J, De Pauw R, Meeus M, Cagnie B, Danneels L, Malfliet A. Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain. Phys Ther. 2021 Jun 1;101(6):
Murillo C, Galán-Martín MÁ, Montero-Cuadrado F, Lluch E, Meeus M, Loh WW. Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care. Pain. 2023 Oct.
Malfliet A Pt MSc, Van Oosterwijck J Pt PhD, Meeus M Pt PhD, Cagnie B Pt PhD, Danneels L Pt PhD, Dolphens M Pt PhD, Buyl R Pt PhD, Nijs J Pt PhD. Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study. Physiother Theory Pract. 2017 Aug;33(8):653-660.
Presenting Author
YV Raghava Neelapala
Poster Authors
Y V Raghava Neelapala
PT
School of Rehabilitation Science, McMaster University, India
Lead Author
Topics
- Other