Background & Aims

Chronic low back pain (LBP) is one of the most prevalent musculoskeletal conditions (1,2) and the main contributor to years lived with disability globally (3). The association between chronic pain and cognitive function propose that an imbalance in the neural pathways, responsible for transmitting pain signals (6,7), combined with the cognitive demands imposed by pain, may lead to an overload on the central nervous system, contributing to cognitive dysfunction (4,5). A systematic review (8) found an association between LBP and different domains of cognitive function. However, cognitive assessment and training are seldom considered in the rehabilitation of people with LBP. Recent guidelines (9) recommended exercise and pain neuroscience education (PNE) for LBP. Therefore, this study aimed to compare the impact of 3 interventions (i) cognitive training, ii) cognitive training plus PNE and exercise iii) PNE and exercise on pain intensity and cognitive functioning of individuals with LBP.

Methods

This was an 8-week, 3-arm randomized parallel intervention (Group I-cognitive training; Group II-PNE, exercise, and cognitive training; Group III-PNE and exercise), with 3 assessment points (baseline, post-intervention, and 3 months follow-up). Participants were assessed for pain intensity using the Numeric Pain Rating scale (10,11) and for cognitive function using the Brain on Track software (12,13). Cognitive training occurred 2 days per week for 45 minutes using the Brain on Track software (14) and covered different domains of cognitive function with progressions made automatically according to individual performance (14). The sessions of PNE were conducted in line with the guidelines for PNE (15,16). Exercises were selected based on clinical practice guidelines (9,17,18), and included trunk muscle strengthening, aerobic exercises, and general exercise (9). Progressions were made considering the evolution of individuals and according to the Borg CR10 (inferior to 3) (19,20).

Results

Ninety-nine participants were randomized to the three groups on a ratio of 1:1. These are preliminary results, and the 3-month follow-up is not yet complete. Preliminary results for pain intensity showed neither a significant interaction of time versus group (p > 0.05; ?2p = 0.005) nor a main effect of time for pain intensity (p > 0.05; ?2p = 0.04). Mean (±SD) pain intensity at baseline was relatively low in all groups (group 1= 3.38 ±2.15; group 2= 3.00±2.24; group 3= 2.90±=2.39). A significant main effect of time was found for cognitive function (p = 0.005; ?2p = 0.091) but not a significant time versus group interaction (p> 0.05; ?2p = 0.002).

Conclusions

Cognitive training alone, as well as in combination with PNE and exercise, or the application of PNE and exercise independently, did not significantly impact pain intensity. Potentially, due to the low pain intensity at baseline. However, all interventions improved cognitive functioning to a similar extent.

References

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Presenting Author

Frederico M. Baptista

Poster Authors

Ellen Pereira Nery

Ms.

Department of Medical Sciences,School of Health Sciences, University of Aveiro, and CINTESIS.UA@RISE

Lead Author

E-mail

Frederico Baptista

University of Aveiro

Lead Author

E-mail

Rosa Andias

CINTESIS.UA@RISE, University of Aveiro

Lead Author

E-mail

Nelson P. Rocha

IEETA and Department of Medical Sciences, University of Aveiro

Lead Author

E-mail

Vitor T. Cruz

Neurology Department, Porto Hospital Center

Lead Author

E-mail

Anabela Silva

Universidade de Aveiro

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Low Back Pain