Therapeutic Neuroscience Education for Patients with Chronic Low Back Pain and Its Effect on Activity Level, Pain Perception, and Function (original) (raw)
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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.
Physiotherapy Theory and Practice, 2014
Acute low back pain (LBP) from injuries is prevalent in the work place. It has been shown that patients with psychosocial factors often progress with persistent pain and lead to significant workers compensation costs. Therapeutic Neuroscience Education (TNE) has been shown to be beneficial in changing a patient's cognition regarding their pain state, which may result in decrease fear, anxiety and catastrophization. A 19-year-old female who developed LBP from a work injury was the patient for this case report. A physical examination, Numeric Pain Rating Scale (NRPS), Oswestry Disability Index (ODI), Fear-Avoidance Beliefs Questionnaire (FABQ), Keele STarT Back Screening Tool (Keele SBST) and Acute Low Back Pain Screening (ALBPS) Questionnaires were assessed during initial physical therapy visit and discharge. Treatment consisted of use of TNE, manual therapy and exercises. She attended five total visits over a 2-week period prior to full discharge. During the initial visit the patient reported NRPS ¼ 3/10, ODI ¼ 36%, FABQ-PA ¼ 23, FABQ-W ¼ 30, Keele SBST ¼ 4/9, ALBPS ¼ 101. At discharge the patient reported a 0 on all outcome questionnaires with ability to return to full work and no pain complaints.
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
Turkish Journal of Physical Medicine and Rehabilitation
Objectives: The aim of this study was to investigate the effect of therapeutic neuroscience education (TNE) combined with physiotherapy on pain, kinesiophobia, endurance, and disability in chronic low back pain (CLBP) patients. Patients and methods: Between November 2016 and December 2017, a total of 31 patients with CLBP (5 males, 26 females; mean age: 42.3±10.8 years; range, 20 to 58 years) were randomly allocated to receive physiotherapy combined with TNE (experimental group, EG, n=16) and physiotherapy alone (control group, CG, n=15). All participants received physiotherapy consisting of five sessions per week for a total of three weeks. In addition to physiotherapy, the EG received TNE sessions consisting of two sessions per week for a total of three weeks. The primary outcomes were pain intensity as assessed by Visual Analog Scale (VAS) and kinesiophobia by Tampa Scale for Kinesiophobia (TSK), while and the secondary outcomes were trunk muscle endurance as assessed by the part...
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.
Pain Practice, 2020
BACKGROUND: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions is yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) with motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. METHODS: Seventy-three patients with CLBP were randomly assigned into PNE plus MCE group (n=37) and GE group (n=36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (Visual Analogue Scale), disability (Roland-Morris Disability Questionnaire), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), and self-efficacy (Pain Self-Efficacy Questionnaire), measured at baseline and 8 weeks post-intervention. A 2 × 2 variance analysis (treatment group × time) with a mixed model design was applied to statistically analyze the data. RESULTS: Both groups showed significant improvements in all the outcome measures with a large effect size (P<0.001, partial eta squared [ηp2] =0.66-0.81) after the intervention. The PNE plus MCE group showed greater improvements with a moderate effect size in pain intensity (P=0.041, ηp2=0.06) and disability (P=0.021, ηp2=0.07) compared to the GE group. No significant difference was found in fear-avoidance beliefs during physical activity and work, and self-efficacy (P>0.05) between the two groups. CONCLUSION: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE while no significant differences were observed for fear-avoidance beliefs and self-efficacy between two groups in patients with CLBP. To conclude on the superiority of individualized interventions over group-based ones, more studies are warranted.
Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil 2011;92:2041-56. Objective: To evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain.