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Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial

Published:November 11, 2017DOI:https://doi.org/10.1016/j.apmr.2017.10.016

      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)
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