Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group‐Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial (original) (raw)
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Syddansk Universitet Neurophysiological Pain Education for Patients With Chronic Low Back Pain
2018
Objective: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). Methods: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Results: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD = −1.03 (95% confidence interval [CI], −0.55 to −1.52), and after 3 months, WMD = −1.09 (95% CI, −2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD = −0.47 (95% CI, −0.80 to −0.13) and after 3 months SMD = −0.38 (95% CI, −0.74 to −0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD = −5.73 (95% CI, −13.60 to 2.14) and after 3 months WMD = −0.94 (95% CI, −6.28 to 4.40). Discussion: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.
Neurophysiological Pain Education for Patients With Chronic Low Back Pain
The Clinical Journal of Pain, 2018
Objective: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). Methods: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Results: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD = −1.03 (95% confidence interval [CI], −0.55 to −1.52), and after 3 months, WMD = −1.09 (95% CI, −2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD = −0.47 (95% CI, −0.80 to −0.13) and after 3 months SMD = −0.38 (95% CI, −0.74 to −0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD = −5.73 (95% CI, −13.60 to 2.14) and after 3 months WMD = −0.94 (95% CI, −6.28 to 4.40). Discussion: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.
Physiotherapy Theory and Practice, 2012
Chronic low back pain (CLBP) remains prevalent in society, and conservative treatment strategies appear to have little effect. It is proposed that patients with CLBP may have altered cognition and increased fear, which impacts their ability to move, perform exercise, and partake in activities of daily living. Neuroscience education (NE) aims to change a patient's cognition regarding their pain state, which may result in decreased fear, ultimately resulting in confrontation of pain barriers and a resumption of normal activities. A 64-year-old female with history of CLBP was the patient for this case report. A physical examination, the Numeric Pain Rating Scale (NPRS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), and Zung Depression Scale were assessed during her initial physical therapy visit, immediately after her first physical therapy session, and at 7-month follow-up. Treatment consisted of an abbreviated NE approach, exercises (range of motion, stretches, and cardiovascular), and aquatic therapy. She attended twice a week for 4 weeks, or 8 visits total. Pre-NE, the patient reported NPRS = 9/10; ODI = 54%; FABQ-W = 25/42,; FABQ-PA = 20/24, and Zung = 58. Immediately following the 75-minute evaluation and NE session, the patient reported improvement in all four outcome measures, most notably a reduction in the FABQ-W score to 2/42 and the FABQ-PA to 1/24. At a 7-month follow-up, all outcome measures continued to be improved. NE aimed at decreasing fear associated with movement may be a valuable adjunct to movement-based therapy, such as exercise, for patients with CLBP.
Journal of Manual & Manipulative Therapy, 2019
Study Design: A prospective, single-arm, pre-postintervention study. Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP). Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined. Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale-NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR. Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC. Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.
Research Square (Research Square), 2023
Background: Chronic low back pain (CLBP) is considered one of the most common health conditions, signi cantly increasing the disease burden worldwide. Several interventions have been used to relieve CLBP. Pain Neuroscience Education (PNE) approach is used to help patients better understand their pain from a biological and physiological perspectives. Specialists also provide it to reduce pain and disability in chronic pain patients. Also, neuromuscular exercises (NMS) are targeted exercises to control impairments presented in CLBP. In this study, PNE combined with NMS is being investigated. Objective: This Randomized Control Trial (RCT) aims to investigate whether a program of NMS combined with PNE on pain, functional disability and psychological factors related to CLBP is effective. Methods/ Design: In this single-blind RCT, 42 patients (men and women, aged 30 to 60) diagnosed with CLBP will be randomly assigned to one of the following groups: (1) PNE plus NMS (21 people) and (2) the NMS (21 people). Outcome assessors will be blinded toward group allocation. The primary outcome will be pain intensity. The secondary outcomes will be disability, fear-avoidance beliefs during work and physical activity, self-e cacy, fear of movement, and kinesiophobia. A blinded assessor will assess all outcomes pre-and post-test. The primary and secondary outcomes will be assessed at baseline and postintervention (8 weeks) and also at 6 months. Discussion: Pain neuroscience education has been recognized as an effective approach to chronic low back pain management. PNE appears to be effective when combined with NME to reduce pain, improve the patient's knowledge of pain, reduce disability and reduce psychosocial factors, increase movement and minimize the use of health care. Therefore, PNE combined with NME is an effective intervention for patients with chronic low back pain. Study registration: The registration reference is IRCT20190427043384N2. Registered on
Fear of Movement/(Re)injury in Chronic Low Back Pain
The Clinical Journal of Pain, 2005
Clinical research of graded exposure in vivo with behavioral experiments in patients with chronic low back pain who reported fear of movement/(re)injury shows abrupt changes in self-reported pain-related fears and cognitions. The abrupt changes are more characteristics of insight learning rather than the usual gradual progression of trial and error learning. The educational session at the start of the exposure might have contributed to this insight. The current study examines the contribution of education and graded exposure versus graded activity in the reduction of pain-related fear and associated disability and physical activity. Six consecutive patients with chronic low back pain who reported substantial fear of movement/(re)injury were included in the study. After a no-treatment baseline measurement period, all the patients received a single educational session, followed again by a no-treatment period. Patients were then randomly assigned to either a graded exposure with behavioral experiments or an operant graded activity program. A diary was used to assess daily changes in pain intensity, pain-related fear, pain catastrophizing, and activity goal achievement. Standardized questionnaires of painrelated fear, pain vigilance, pain intensity, and pain disability were administered before and after each intervention and at the 6-month follow-up. An activity monitor was carried at baseline, during the interventions, and 1 week at 6-month follow-up. Randomization tests of the daily measures showed that improvements in pain-related fear and catastrophizing occurred after the education was introduced. The results also showed a further improvement when exposure in vivo followed the no-treatment period after the education and not during the operant graded activity program. Performance of relevant daily activities, however, were not affected by the educational session and improved significantly only in the exposure in vivo condition. All improvements remained at half-year follow-up only in patients receiving the exposure in vivo. These patients also reported a significant decrease in pain intensity at follow-up.
Archives of Physiotherapy, 2015
Background: Psychosocial factors precipitate and perpetuate the risk of developing long-term Low-Back Pain (LBP) with resultant disability. However, management of psychosocial aspects of LBP still remains a major challenge. This study investigated the effect of static or dynamic back extensors endurance exercise on psychosocial variables of Fear-Avoidance Behaviour (FAB), Pain Self-Efficacy Belief (PSEB) and Back Pain Consequences Belief (BPCB) in patients with LBP. Methods: A randomized-controlled trial of 67 patients assigned into McKenzie Protocol (MP) group (n = 25), MP and Static Endurance Exercise Group (MPSEEG; n = 22); and MP and Dynamic Endurance Exercise Group (MPDEEG; n = 20) was carried out. Treatment was applied thrice weekly for eight weeks. Results: The groups were comparable in general and baseline psychosocial parameters (p > 0.05). The different regimens had significant effects on all outcome parameters across baseline, 4 th and 8 th week (p < 0.05). The regimens were comparable in mean change scores on BPCB and FAB at the 4th and 8th week respectively (p > 0.05). MPDBEEG had higher mean change in PSEB at the 4 th and 8 th week respectively. Conclusions: McKenzie Protocol alone, or in combination with static or dynamic back extensors endurance exercise has comparable effect on FAB, PSEB and BPCB in patients with LBP. The addition of dynamic endurance exercise to the MP led to significantly higher positive effects on PSEB.
The Spine Journal, 2014
BACKGROUND CONTEXT: Psychological factors are believed to influence the development of chronic low back pain. To date, it is not known how fear-avoidance beliefs (FABs) influence the treatment efficacy in low back pain. PURPOSE: To summarize the evidence examining the influence of FABs measured with the Fear-Avoidance Belief Questionnaire or the Tampa Scale of Kinesiophobia on treatment outcomes in patients with low back pain. STUDY DESIGN/SETTING: This is a systematic review. PATIENT SAMPLE: Patients with low back pain. OUTCOME MEASURES: Work-related outcomes and perceived measures including return to work, pain, and disability. METHODS: In January 2013, the following databases were searched: BIOSIS, CINAHL, Cochrane Library, Embase, OTSeeker, PeDRO, PsycInfo, PubMed/Medline, Scopus, and Web of Science. A hand search of the six most often retrieved journals and a bibliography search completed the search. Study eligibility criteria, participants, and interventions: research studies that included patients with low back pain who participated in randomized controlled trials (RCTs) investigating nonoperative treatment efficacy. Out of 646 records, 78 articles were assessed in full text and 17 RCTs were included. Study quality was high in five studies and moderate in 12 studies. RESULTS: In patients with low back pain of up to 6 months duration, high FABs were associated with more pain and/or disability (4 RCTs) and less return to work (3 RCTs) (GRADE high-quality evidence, 831 patients vs. 322 in nonpredictive studies). A decrease in FAB values during treatment was associated with less pain and disability at follow-up (GRADE moderate evidence, 2 RCTs with moderate quality, 242 patients). Interventions that addressed FABs were more effective than control groups based on biomedical concepts (GRADE moderate evidence, 1,051 vs. 227 patients in studies without moderating effects). In chronic patients with LBP, the findings were less consistent. Two studies found baseline FABs to be associated with more pain and disability and less return to work (339 patients), whereas 3 others (832 patients) found none (GRADE low evidence). Heterogeneity of the studies impeded a pooling of the results. CONCLUSIONS: Evidence suggests that FABs are associated with poor treatment outcome in patients with LBP of less than 6 months, and thus early treatment, including interventions to reduce FABs, may avoid delayed recovery and chronicity. Patients with high FABs are more likely to FDA device/drug status: Not applicable. improve when FABs are addressed in treatments than when these beliefs are ignored, and treatment strategies should be modified if FABs are present. Ó
The Clinical Journal of Pain, 2013
Objective: To evaluate the effect on disability, kinesiophobia, pain, and the quality of life of a long-lasting multidisciplinary program based on cognitive-behavioral therapy and targeted against fearavoidance beliefs in patients with chronic low back pain. Methods: Study design: parallel-group, randomized, superiority controlled study. Ninety patients were randomly assigned to a multidisciplinary program consisting of cognitive-behavior therapy and exercise training (experimental group, 45 patients) or exercise training alone (control group, 45 patients). Before treatment (T1), 5 weeks later (instructive phase, T2), and 12 (posttreatment analysis, T3) and 24 months after the end of the instructive phase (1-year follow-up, T4), all of the patients completed a booklet containing the Roland-Morris Disability Questionnaire Scale (primary outcome), the Tampa Scale for Kinesiophobia, a pain numerical rating scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used to analyze each outcome measure, and the reliable change index/clinically significant change method was used to assess the clinical significance of the changes. Results: The linear mixed model analysis showed a remarkable group, time, and interaction effect for group * time in all of the primary and secondary outcomes (P always <0.001). The majority of the patients in the experimental group achieved a reliable and clinically significant improvement, whereas the majority of those in the control group experienced no change. Conclusions: The long-lasting multidisciplinary program was superior to the exercise program in reducing disability, fearavoidance beliefs and pain, and enhancing the quality of life of patients with chronic low back pain. The effects were clinically tangible and lasted for at least 1 year after the intervention ended.