Background & Aims
Chronic pain affects not only adults but also children and adolescents and significantly impairs their physical, social, and psychological functioning [1, 2]. There is evidence for the effect of Pain Neuroscience Education (PNE) on the prevention and treatment of pain in adults [3-6], and initial studies in schools have also shown positive effects [7-10]. However, there have been no comparable school-based PNE studies in Germany.
Since schools are thought to play an important role in managing and preventing a further increase in the pain pandemic [11], the first aim of this study was to determine the effect of PNE (PNE versus no PNE) on students’ pain knowledge. The second aim was to determine the impact of PNE (PNE versus no PNE) on fear-avoidance beliefs, pain catastrophizing, functional limitations, pain, and students’ healthcare decisions related to pain. The third aim was to investigate whether PNE is effective in different subgroups according to educational level and pain type.
Methods
250 students (age 12 ±1 years) from 15 classes in 5 schools were assigned to two study groups. The PNE(1)-group (n=107) received the PNE at the beginning of the 14-week study period, while the PNE(2)-group (n=143) received it at the end. The measurement time points for the PNE(1)-group were Baseline (before PNE), after PNE, and after 14 weeks. The measurement time points for the PNE(2)-group were Baseline, after 14 weeks (before PNE), and after PNE. The primary outcome was pain knowledge assessed by the Neurophysiology of Pain Questionnaire (NPQ-D). Secondary outcomes were fear-avoidance beliefs, pain catastrophizing, functioning in daily life, various pain parameters, and healthcare choices for pain. Two-way repeated measures analysis of variance (ANOVA) were performed to compare the effect of the PNE with the effect without the PNE and repeated measures ANOVA to determine the within-group effect of the PNE in each group. Categorical outcome variables were analyzed using Chi² tests.
Results
The PNE(1)-group had significantly higher mean NPQ-D scores after 14 weeks compared to the PNE(2)-group, which had not received the PNE at this time (F[1,248]=18.280, p<0.001, ?p²=0.069). The within-group analysis of each group and its subgroups revealed a significant increase in the mean NPQ-D scores from before the PNE to after the PNE at the respective measurement time points. No significant effects were found for most secondary outcome parameters after 14 weeks. In the PNE(1) group, the mean pain intensity increased slightly, and subgroup analysis by type of pain showed a higher utilization of the healthcare system. A secondary analysis showed that in the subgroup of students with chronic pain, fewer students in the PNE(1) group (28.2%) had not taken any pain medication or had taken it only once in the last three months at follow-up than in the PNE(2) group (33.4%), compared with baseline (41.6% and 35.5%, respectively).
Conclusions
In this study, the one-time school-based PNE had a large effect on pain knowledge from pre-PNE to post-PNE and was more effective in maintaining pain knowledge at the 14-week follow-up compared with no PNE. It can, therefore, be considered an effective method for teaching science-based content and changing 7th-grade students’ knowledge about pain, especially among grammar school students and students without chronic pain. Certain messages were identified within the PNE that should be refined so that students from all subgroups can benefit from the intervention. Overall, the PNE did not significantly impact most secondary outcome parameters over time. Yet, a slight increase in pain intensity among students who received the PNE and a proportionate increase in healthcare utilization were also observed in the pain type subgroups, with the group that had received the PNE. However, encouraging trends were observed in medication use among students with chronic pain.
References
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