Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study (original) (raw)
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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.
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.
2013
Background: Chronic low back pain (CLBP) is a significant cause of disability and inactivity in the United States. Patients with chronic pain are often symptomatic even in the absence of tissue damage. This is a major reason patients need to be educated about their pain. Cognitions such as fear, anxiety and faulty beliefs may impact the pain experiences and changing cognitions are important in changing pain behavior. If patients understand that the pain they are experiencing may not be a true indication of the health of their tissues, they may experience less fear of their pain, and may be able to return to previous activities. Purpose : To determine if a one-hour one-on-one therapeutic neuroscience education (TNE) session for patients with CLBP would have a positive effect on their pain, perceptions, function, and activity level. Subjects : Participants (2 males, 5 females mean age 38.3 years) who had been experiencing low back pain for >1 year and did not have a current exacerb...
Disability and Rehabilitation, 2015
Purpose: Chronic whiplash-associated disorders (WAD) incur both costs and suffering. Treatments that can relieve chronic WAD are therefore needed. Exercise therapy (ET) has been shown to provide pain relief. Another often used treatment for chronic pain in Scandinavia is basic body awareness therapy (BAT). We compared the effectiveness of 10 weeks of twice-weekly, 90-min sessions of either ET or BAT in a randomized comparative trial. Method: We recruited 113 patients suffering from chronic WAD grades I-III and several years' duration of symptoms in a primary health care setting. 57 were allocated to ET and 56 to BAT. Primary outcome measures were Neck Disability Index and SF-36 v.2. Results: From baseline to posttreatment, the BAT group increased their physical functioning (median 5, IQR ¼ 15) more than the ET group (median ¼ 0, IQR ¼ 15), p ¼ 0.032, effect size À0.54. Three months after the end of treatment, the BAT group had less bodily pain (m ¼ 17.5, 95% CI 6.9-17.6) than the ET group (m ¼ 4.9, 95% CI À0.1 to 9.8), p ¼ 0.044, effect size À0.4. The BAT group had also increased their social functioning (m ¼ 13.3, 95% CI 6.6-19.9) more than the ET group (m ¼ 3.5, 95% CI À3 to 9.9), p ¼ 0.037, effect size À0.41. No statistically significant differences between groups were found for the change of other outcomes. No serious adverse effects were found in either groups. Conclusions: The present trial indicates that BAT led to greater improvements than ET for the patients with chronic WAD. ä Implications for Rehabilation Chronic whiplash-associated disorders are disabling and incur great costs to society often through inability to work. Exercise therapy (ET) may alleviate symptoms of chronic WAD. Basic body awareness therapy (BAT) is often a component of multimodal pain rehabilitation programs. In this randomized comparative trial, BAT increased physical functioning and led to greater pain reduction and social functioning 3 months after the end of treatment.
BMC Musculoskeletal Disorders, 2011
Background: Many patients suffer from chronic neck pain following a whiplash injury. A combination of cognitive, behavioural therapy with physiotherapy interventions has been indicated to be effective in the management of patients with chronic whiplash-associated disorders. The objective is to present the design of a randomised controlled trial (RCT) aimed at evaluating the effectiveness of a combined individual physical and cognitive behavioural-graded activity program on self-reported general physical function, in addition to neck function, pain, disability and quality of life in patients with chronic neck pain following whiplash injury compared with a matched control group measured at baseline and 4 and 12 months after baseline.
The efficacy of patient education in whiplash associated disorders: a systematic review
Pain physician
Until now, there is no firm evidence for conservative therapy in patients with chronic Whiplash Associated Disorders (WAD). While chronic WAD is a biopsychosocial problem, education may be an essential part in the treatment and the prevention of chronic WAD. However, it is still unclear which type of educative intervention has already been used in WAD patients and how effective such interventions are. This systematic literature study aimed at providing an overview of the literature regarding the currently existing educative treatments for patients with whiplash or WAD and their evidence. Systematic review of the literature. A systematic literature search was conducted in the following databases: Pubmed, Springerlink, and Web of Science using different keyword combinations. We included randomized controlled clinical trials (RCT) that encompass the effectiveness of education for patients with WAD. The included articles were evaluated on their methodological quality. Ten RCT's of m...
Assessing pain perception using the Painmatcher® in patients with whiplash-associated disorders
Journal of Rehabilitation Medicine, 2008
Objective: To evaluate the Painmatcher ® , in terms of reliability, and to explore the relationship between pain magnitude matching and pain threshold assessments in patients with whiplash-associated disorders. Also, to investigate gender differences in pain thresholds and explore the correlation between pain-related cognitions and pain threshold. Design: A test-retest study.
A randomized controlled trial of intensive neurophysiology education in chronic low back pain
The Clinical journal of …, 2004
Objectives: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance.