Syddansk Universitet Neurophysiological Pain Education for Patients With Chronic Low Back Pain (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.
Manual Therapy, 2011
Pain neurophysiology education (PNE) is a form of education for patients with chronic low back pain (CLBP). The purpose of this systematic review was to investigate the evidence for PNE in the management of pateints with CLBP. A literature search of MEDLINE, CINAHL and AMED was performed from 1996(01)e2010(09). RCT appraisal and synthesis was assessed using the Cochrane Back Review Group (CBRG) guidelines. The main outcome measures were pain, physical-function, psychological-function, and social-function. Two moderate quality RCTs (n ¼ 122) were included in the final review. According to the CBRG criteria there was very low quality evidence that PNE is beneficial for pain, physical-function, psychological-function, and social-function. Meta-analysis found PNE produced statistically significant but clinically small improvements in short-term pain of 5 mm (0, 10.0 mm) [mean difference (95%CI)] on the 100 mm VAS. This review was limited by the small number of studies (n ¼ 2) that met the inclusion criteria and by the fact that both studies were produced by the same group that published the PNE manual. These factors contributed to the relatively low grading of the evidence. There is a need for more studies investigating PNE by different research groups to support early promising findings. Until then firm clinical recommendations cannot be made.
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.
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.
Effects of dynamic stabilization exercises and muscle energy technique on selected biopsychosocial outcomes for patients with chronic non-specific low back pain: a double-blind randomized controlled trial, 2021
Objectives: Low back pain is the most prevalent musculoskeletal condition, and causes activity limitations which result in reduced work productivity and high medical expenditure. The management of this condition has been challenging to both clinicians and researchers. While the use of Muscle Energy Technique (MET) as a potentially effective treatment strategy seems promising, studies examining MET combined with exercise therapy are scarce and studies with strong methodology are lacking. Therefore, this study aims to determine the effects of a combination of Dynamic Stabilization Exercises (DSE) and MET on selected biopsychosocial outcomes compared to DSE alone or conventional physiotherapy in the management of chronic non-specific low back pain (NSLBP). Methods: A total of 125 (80 male and 45 female) patients with chronic NSLBP were involved in this study, they were recruited from Rasheed Shekoni Teaching hospital and Federal Medical centre Birnin-Kudu, Jigawa State, Nigeria. A random number generator method was used to allocate patients to either DSE + MET (n=41), DSE alone (n=39) or conventional physiotherapy (n=45). Interventions were administered twice a week over 12 weeks. Outcome measures included pain intensity, lumbar (flexion and extension) range of motion, functional-disability, self-perceived health status, limitations in activities and participation restrictions. These were assessed at baseline, midintervention at six weeks, post-intervention at 12 weeks and long term follow-up at 24 weeks. Data was analyzed using repeated-measures ANOVA to determine significance difference within groups and between groups. Results: All intervention groups showed within-groups changes of the study outcomes over time (p<0.001). However, between-group comparisons showed greater improvements in pain intensity (F=7.91, p<0.001), lumbar ROM (flexion F=1.51, p<0.001; extension F=3.25, p<0.001), activity limitations/participation restrictions (F=3.7, p<0.001) and health status (F=10.9, p<0.001) for the intervention in which MET and DSE were combined. The MET plus DSE interventions were superior to DSE and convention physiotherapy for all outcome measures, except for functional disability (F=0.53, p=0.590). Conclusions: The data from this study showed MET combined with DSE had greater therapeutic benefits compared to DSE or conventional physiotherapy on selected biopsychosocial outcomes in patients with chronic NSLBP. The findings from the study show that the combination of MET with DSE is safe and has beneficial effects in the management of patients with chronic NSLBP. Clinical trial registration: The study protocol has been registered with www.ClinicalTrial.gov with the registration number NCT3449810.
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.
Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain
Physical Therapy, 2021
Background Pain neuroscience education (PNE) combined with cognition-targeted exercises is an effective treatment for people with chronic spinal pain (CSP). However, it is unclear why some patients benefit more from this treatment. We expect that patients with more pronounced maladaptive pain cognitions, such as kinesiophobia, might show poorer treatment responses. Objective The objective of this study was to assess the influence of baseline kinesiophobia levels on the treatment outcomes of PNE combined with cognition-targeted exercises in people with CSP. This study was a secondary analysis of a multicenter, double-blind, randomized controlled trial. Methods Outcome measures included a numeric rating scale for pain (NRS), the Pain Disability Index (PDI), quality of life (Medical Outcomes Study 36-Item Health Survey [SF-36]), Pain Catastrophizing Scale (PCS), and Pain Vigilance and Awareness Questionnaire (PVAQ). Regression models were built using treatment (PNE plus cognition-targe...
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.
Pain Education in the Management of Patients with Chronic Low Back Pain: A Systematic Review
Journal of Functional Morphology and Kinesiology
New prospective of chronic low back pain (CLBP) management based on the biopsychosocial model suggests the use of pain education, or neurophysiological pain education, to modify erroneous conceptions of disease and pain, often influenced by fear, anxiety and negative attitudes. The aim of the study is to highlight the evidence on the outcomes of a pain education-oriented approach for the management of CLBP. The search was conducted on the Pubmed, Scopus, Pedro and Cochrane Library databases, leading to 2673 results until September 2021. In total, 13 articles published in the last 10 years were selected as eligible. A total of 6 out of 13 studies support a significant reduction in symptoms in the medium term. Disability is investigated in only 11 of the selected studies, but 7 studies support a clear reduction in the medium-term disability index. It is difficult to assess the effectiveness of the treatments of pain education in patients affected by CLBP, due to the multimodality and ...