Pain neuroscience education in patients with chronic spinal pain may improve kinesiophobia and the perceived negative consequences and cyclicity of illness, according to a study published in Pain Medicine & Rehabilitation.
A total of 120 patients with chronic spinal pain who reported either high or low symptoms of central sensitization based on the 25-item Central Sensitization Inventory total score were included in the multicenter triple-blind randomized controlled trial. Investigators randomly assigned patients to the pain neuroscience education group (n=60) or neck/back school (n=60).
Participants in the education group received education on the neurophysiology of pain (ie, information on synapses, neurons, descending nociceptive inhibition and facilitation, peripheral sensitization, and central sensitization).
Patients in the control group received education on the course and causes of neck/back pain, anatomy and physiology of spinal bones and joints, ergonomic advice, lifting techniques, and the value behind exercise. Sessions were delivered in 1 group session, 1 online session, and 1 individual session within a 2-week period.
Pain disability, the study’s primary outcome, was comparable in both groups at the end of the training period (P =.242). In the neuroscience education group, significant interactions were established between baseline levels of central sensitization and the following pain catastrophizing items (ie, greater effect of the intervention in individuals with high vs low levels of sensitization): pain catastrophizing (P =.02 to P =.05), kinesiophobia (P =.02), chronicity (P =.002), negative consequences (P =.02), personal control (P =.02), and cyclicity (P =.02).
Only those in the pain neuroscience education group showed an improvement in kinesiophobia (P <.001, medium effect sizes), perceived negative consequences (P =.004 and P <.001, small to medium effect sizes), and perceived cyclicity of their illness (P =.01 and P =.01, small effect sizes).
A limitation of the study was the short follow-up period and the highly heterogeneous patient population.
“[T]hese results imply the use of pain neuroscience education over neck/back school in clinical practice in patients with nonspecific chronic spinal pain regardless of their baseline levels of self-reported symptoms of central sensitization,” concluded the study authors.
Malfliet A, Kregel J, Meeus M, et al. Patients with chronic spinal pain benefit from pain neuroscience education regardless the self-reported signs of central sensitization: secondary analysis of a randomized controlled multicenter trial [published online May 9, 2018]. PM R. doi: 10.1016/j.pmrj.2018.04.010