Abstract
Objective
To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic
exercise (TE) for patients with chronic low back pain (CLBP).
Design
Single-blind randomized controlled trial.
Setting
Private clinic and university.
Participants
Patients with CLBP for ≥6 months (N=56).
Interventions
Participants were randomized to receive either a TE program consisting of motor control,
stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE
program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants.
Main Outcomes Measures
The primary outcome was pain intensity rated on the numerical pain rating scale which
was completed immediately after treatment and at 1- and 3-month follow-up. Secondary
outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris
Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia,
and Patient Global Impression of Change.
Results
At 3-month follow-up, a large change in pain intensity (numerical pain rating scale:
−2.2; −2.93 to −1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed
for the secondary outcome measures.
Conclusions
Combining PNE with TE resulted in significantly better results for participants with
CLBP, with a large effect size, compared with TE alone.
Keywords
List of abbreviations:
CLBP (chronic low back pain), MCID (minimal clinically important difference), NPRS (numerical pain rating scale), PCS (Pain Catastrophizing Scale), PGIC (Patient Global Impression of Change), PNE (pain neurophysiology education), RMDQ (Roland-Morris Disability Questionnaire), TE (therapeutic exercise), TSK-11 (Tampa Scale for Kinesiophobia)To read this article in full you will need to make a payment
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References
- A systematic review of the global prevalence of low back pain.Arthritis Rheum. 2012; 64: 2028-2037
- Chapter 4. European guidelines for the management of chronic nonspecific low back pain.Eur Spine J. 2006; 15 Suppl 2: S192-S300
- Low back pain in primary care: costs of care and prediction of future health care utilization.Spine. 2010; 35: 1714-1720
- Low back pain and sciatica: summary of NICE guidance.BMJ. 2017; 356: i6748
- Motor control exercise for persistent, nonspecific low back pain: a systematic review.Phys Ther. 2009; 89: 9-25
- Motor control exercise for chronic non-specific low-back pain.Cochrane Database Syst Rev. 2016; : CD012004
- Pain treatment for patients with osteoarthritis and central sensitization.Phys Ther. 2013; 93: 842-851
- Effect sizes of non-surgical treatments of non-specific low-back pain.Eur Spine J. 2007; 16: 1776-1788
- Central sensitization: implications for the diagnosis and treatment of pain.Pain. 2011; 152: S2-S15
- Joining forces–combining cognition-targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain.J Man Manip Ther. 2003; 11: 88-94
- A randomized controlled trial of intensive neurophysiology education in chronic low back pain.Clin J Pain. 2004; 20: 324-330
- Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial.Man Ther. 2010; 15: 382-387
- The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain.Arch Phys Med Rehabil. 2011; 92: 2041-2056
- The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature.Physiother Theory Pract. 2016; 32: 332-355
- The common-sense model of self-regulation (CSM): a dynamic framework for understanding illness self-management.J Behav Med. 2016; 39: 935-946
- Catastrophizing and internal pain control as mediators of outcome in the multidisciplinary treatment of chronic low back pain.Eur J Pain. 2004; 8: 211-219
- Combined physiotherapy and education is efficacious for chronic low back pain.Aust J Physiother. 2002; 48: 297-302
- Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial.Arch Phys Med Rehabil. 2010; 91: 1153-1159
- Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study.J Rehabil Res Dev. 2011; 48: 43-58
- Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial.Clin J Pain. 2013; 29: 873-882
- CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials.J Clin Epidemiol. 2010; 63: e1-e37
- Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial.BMC Musculoskelet Disord. 2014; 15: 149
- Core outcome measures for chronic pain clinical trials: IMMPACT recommendations.Pain. 2005; 113: 9-19
- Responsiveness of the numeric pain rating scale in patients with low back pain.Spine. 2005; 30: 1331-1334
- Assessing change over time in patients with low back pain.Phys Ther. 1994; 74: 528-533
- Validation of the spanish version of the Roland-Morris questionnaire.Spine (Phila Pa 1976). 2002; 27: 538-542
- The Roland–Morris disability questionnaire and the Oswestry disability questionnaire.Spine. 2000; 25: 3115-3124
- [Validation of the Spanish version of the Pain Catastrophizing Scale in fibromyalgia].Med Clin (Barc). 2008; 131 ([Spanish]): 487-492
- Fear and avoidance of movement in people with chronic pain: psychometric properties of the 11-item Tampa Scale for Kinesiophobia (TSK-11).Physiother Can. 2012; 64: 235-241
- Psychometric properties of the Spanish version of the Tampa Scale for Kinesiophobia (TSK).J Pain. 2011; 12: 425-435
- Clinically important outcomes in low back pain.Best Pract Res Clin Rheumatol. 2005; 19: 593-607
- Validity, reliability, and responsiveness of the fingertip-to-floor test.Arch Phys Med Rehabil. 2001; 82: 1566-1570
- Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values.Pain. 2006; 123: 231-243
- Pressure pain thresholds in different tissues in one body region. The influence of skin sensitivity in pressure algometry.Scand J Rehabil Med. 1999; 31: 89-93
- Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.Clin J Pain. 2007; 23: 760-766
- Motor control exercise for chronic low back pain: a randomized placebo-controlled trial.Phys Ther. 2009; 89: 1275-1286
- La guía completa de los estiramientos.Editorial Paidotribo, Barcelona2007
- Sunyata. Explain pain.Noigroup Publications, Adelaide2003
- G* Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behav Res Methods. 2007; 39: 175-191
- Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial.Clin Rehabil. 2015; 29: 538-547
- Exercise and chronic low back pain: what works?.Pain. 2004; 107: 176-190
- Pain neurophysiology education for the management of individuals with chronic low back pain: a systematic review and meta-analysis.Man Ther. 2011; 16: 544-549
- Evidence for central sensitization in chronic whiplash: a systematic literature review.Eur J Pain. 2013; 17: 299-312
- Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up.Spine (Phila Pa 1976). 2014; 39: 1449-1457
- A neuroscience approach to managing athletes with low back pain.Phys Ther Sport. 2012; 13: 123-133
- Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain.Eur J Pain. 2004; 8: 39-45
- Fifteen years of explaining pain: the past, present, and future.J Pain. 2015; 16: 807-813
- The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes in an outpatient chronic pain sample.J Pain. 2013; 14: 438-445
- Balancing “hands-on” with “hands-off” physical therapy interventions for the treatment of central sensitization pain in osteoarthritis.Man Ther. 2015; 20: 349-352
- A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training.Phys Ther. 2014; 94: 730-738
- Exercise therapy for chronic musculoskeletal pain: innovation by altering pain memories.Man Ther. 2015; 20: 216-220
Article info
Publication history
Published online: November 11, 2017
Footnotes
Clinical Trial Registration No.: ACTRN12617000097347.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
