Pain Physiology Education Improves Health Status and Endogenous Pain Inhibition in Fibromyalgia: A Double-Blind Randomized Controlled Trial

*Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel ‡Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels †Department of Health Care Sciences, Division of Musculoskeletal Physiotherapy, Artesis University College Antwerp, Antwerp ∥Private Practice for Internal Medicine, Gent/Aalst, Belgium §Nursing and Health Care, School of Medicine, University of Glasgow, Glasgow, UK.
The Clinical journal of pain (Impact Factor: 2.53). 01/2013; 29(10). DOI: 10.1097/AJP.0b013e31827c7a7d
Source: PubMed


There is evidence that education on pain physiology can have positive effects on pain, disability, and catastrophization in patients with chronic musculoskeletal pain disorders. A double-blind randomized controlled trial (RCT) was performed to examine whether intensive pain physiology education is also effective in fibromyalgia (FM) patients, and whether it is able to influence the impaired endogenous pain inhibition of these patients.

Thirty FM patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education). The primary outcome was the efficacy of the pain inhibitory mechanisms, which was evaluated by spatially accumulating thermal nociceptive stimuli. Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status. Assessments were performed at baseline, 2 weeks, and 3 months follow-up. Repeated measures ANOVAS were used to reveal possible therapy effects and effect sizes were calculated.

After the intervention the experimental group had improved knowledge of pain neurophysiology (P<0.001). Patients from this group worried less about their pain in the short term (P=0.004). Long-term improvements in physical functioning (P=0.046), vitality (P=0.047), mental health (P<0.001), and general health perceptions (P<0.001) were observed. In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition (P=0.041) compared with the control group.

These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.

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Available from: Jessica Van Oosterwijck, Jan 21, 2014
    • "Early evidence supports the potential of PNE to contribute, alongside other methods, towards the reduction of pain and disability, although the evidence is limited because of the few studies that have investigated this intervention (Moseley, 2003a, 2004; Ryan et al., 2010; Clarke et al., 2011; Van Oosterwijck et al., 2011; Louw et al. 2011; Van Oosterwijck et al. 2013; Pires et al. 2015). There is evidence supporting claims that PNE, delivered in a variety of ways, can help to alter inappropriate beliefs, reduce catastrophizing and diminish fear, consistent with the claimed mechanism of reconceptualisaton (Clarke et al., 2011; Van Oosterwijck et al., 2011; Louw et al. 2011). "
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    ABSTRACT: Pain neurophysiology education (PNE) is a distinct form of patient education in pain management. The aims of this study were to explore the experience of PNE for people with chronic pain and to gain insight into their understanding of their pain after PNE. This was a qualitative study, based on Interpretive Phenomenology Analysis, using individual semi-structured interviews to collect data. We recruited a purposive sample of 10 adults with chronic musculoskeletal pain (men and women; mean age 48 years; with a mean pain duration of 9 years) who had recently completed PNE delivered as a single 2-h group session. The interview transcripts were analysed for emerging themes. We identified three themes: perceived relevance for the individual participant; perceived benefits for the individual participant; and evidence of reconceptualisation. An interlinking narrative was the importance of relevance. Eight participants viewed the session as relevant and reported benefits ranging from a better understanding of pain, improved ability to cope with the pain, and some suggested improved levels of physical activity. Four of these participants showed evidence of reconceptualisation, which we describe as partial and patchy. Two participants reported no benefit and did not perceive the material delivered within PNE to be relevant to themselves. Relevance to the individual needs of a person with chronic pain may be a key factor in the success of PNE, and this is a particular challenge when it is delivered in a group situation.
    Manual therapy 10/2015; DOI:10.1016/j.math.2015.10.001 · 1.71 Impact Factor
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    • "In the last 15 years there has been a significant increase in teaching people about the biology and physiology of their pain, referred to as pain neuroscience education (PNE) (Louw, Diener, Butler, and Puentedura, 2011; Moseley, 2003a; Moseley, 2004; Moseley, Nicholas, and Hodges, 2004; Moseley 2005). Two systematic reviews and a series of randomized controlled trials (RCT) have shown a positive effect of PNE in patients with mainly chronic pain in reducing pain scores, pain catastrophization , and disability and improving physical performance (Clarke, Ryan, and Martin, 2011; Louw, Diener, Butler, and Puentedura, 2011; Moseley, 2002, 2003a; Moseley, Nicholas, and Hodges, 2004; Ryan, Gray, Newton, and Granat, 2010; Van Oosterwijck et al, 2013). Recent research has also shown positive effects of PNE on acute conditions including low back pain (LBP) (Zimney, Louw, and Puentedura, 2014) and patients undergoing lumbar surgery for radiculopathy (Louw, Diener, Landers, and Puentedura, 2014; Puentedura, Brooksby, Wallmann, and Landers, 2009). "
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    ABSTRACT: Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.
    Physiotherapy Theory and Practice 10/2015; 31(8):1-6. DOI:10.3109/09593985.2015.1062944
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    • "Evidence supporting the capacity of PNE to desensitize the CNS comes from a recent trial in patients with fibromyalgia (Van Oosterwijck et al., 2013). Though sometimes provided separately, PNE seems to be more effective when administered in conjunction with other physical therapy interventions (Louw et al., 2011). "
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    ABSTRACT: Traditional understanding of osteoarthritis-related pain has recently been challenged in light of evidence supporting a key role of central sensitization in a subgroup of this population. This fact may erroneously lead musculoskeletal therapists to conclude that hands-on interventions have no place in OA management, and that hands-off interventions must be applied exclusively. The aim of this paper is to encourage clinicians in finding an equilibrium between hands-on and hands-off interventions in patients with osteoarthritis-related pain dominated by central sensitization. The theoretical rationale for simultaneous application of manual therapy and pain neuroscience education is presented. Practical problems when combining these interventions are also addressed. Future studies should explore the combined effects of these treatment strategies to examine whether they increase therapeutic outcomes against current approaches for chronic osteoarthritis-related pain.
    Manual Therapy 08/2014; 20(2). DOI:10.1016/j.math.2014.07.017 · 1.71 Impact Factor
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