Article

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

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Abstract

Objectives: 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. Methods: 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. Results: 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. Discussion: 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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... We identified a total of 1468 studies with the electronic search ( Figure 1). Ten studies met the eligibility criteria and were included in the systematic review [21][22][23][24][25][26][27][28][29][30]. The kappa coefficient for inter-reviewer concordance for full text selection was 0.89. ...
... The 10 randomised controlled trials included a total sample of 949 patients. The studies included patients with fibromyalgia [21,27,29], chronic neck pain [22][23][24][25]28], chronic low back pain (CLBP) [23,24,30], chronic pain without specification [22,26] and chronic shoulder pain [22]. ...
... The included studies examined the following variables of interest: anxiety [21,22,27,28], hypervigilance [23,24,29], knowledge of pain [25,26,29,30] and attitudes and beliefs [28,30]. ...
Article
Background Chronic pain is a global problem, with a prevalence of 35–50%. This multifactorial condition is influenced by biological, psychological, and social factors. Objectives We assessed the efficacy of pain neuroscience education (PNE) on psychoemotional and cognitive variables in individuals with chronic musculoskeletal pain. Methods We searched the PubMed, PEDro, Scopus, Web of Science, and CINHAL databases. We included randomised controlled trials conducted in adults with chronic musculoskeletal pain undergoing with PNE. The authors of these papers evaluated hypervigilance, attitudes and beliefs, knowledge of pain, and/or anxiety. We assessed risk of bias by using the ROB 2.0 tool. We performed a GRADE analysis to determine the quality of the evidence. We have reported the results using descriptive statistics and narrative synthesis. Results We included 10 articles that had implemented PNE. There were moderate to high effect sizes for the variables anxiety and knowledge of neurophysiology of pain and a moderate effect size for hypervigilance. Heterogeneity in the diagnosis of the participants, interventions, and follow-up periods did not allow us to perform a meta-analysis. Conclusions The results suggest that there are benefits of PNE alone or in combination with another therapeutic modality. However, more research is required.
... Several studies have assessed patient pain neurophysiology knowledge and clinical outcomes before and after PSE, but the associations between changes in knowledge with changes in outcomes have seldom been examined. 10,[15][16][17][18][19][20][21][22][23][24][25][26][27] Using mediation analysis, Lee et al 10 showed that improved pain neurophysiology knowledge after PSE was significantly associated with a reduction in pain intensity (total effect = −1.34, 95% CI = −2.12 to −0.55) and improved physical function (total effect = 1.70, 95% CI = 1. ...
... to 0.45, P = 0.77). 21 Similarly, there was no significant short-term association between the change in pain neurophysiology knowledge with change in the mental component of the SF-12 in any study (n = 8, r = 0.08, 95% CI = −0.74 to 0.66, P = 0.85), 19 (n = 162, r = 0.08, 95% CI = −0.23 to 0.08, P = 0.32), 17 Kinesiophobia Eight studies reported kinesiophobia using different versions of the Tampa Scale of Kinesiophobia. 38 Short-term outcomes revealed no association between change in pain neurophysiology knowledge with change in kinesiophobia (n = 152, r = −0.02, ...
... 95% CI = −0.20 to 0.10, I 2 = 35%) or PSE combined with exercise (n = 81, r = 0.03, 95% CI = −0.33 to 0.39, I 2 = 40%). Three studies reported long-term outcomes, of which 1 identified a moderate, nonsignificant association at 3 months (n = 15, r = 0.366, 95% CI = −0.19 to 0.74, P = 0.18) 21 and another reported a weak, nonsignificant association at 3 months (n = 45, r = 0.10, 95% CI = −0.23 to 0.42, P = 0.54, n = 36). 18 The third study reported 2 longterm follow-up points, both with moderate and significant associations between improved pain neurophysiology knowledge and reduced pain catastrophizing (6 mo: n = 724, r = −0.23, ...
Article
Objective: This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. Methods: Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. Results: Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12 wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. Discussion: These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).
... Two articles that used SSP as an indicator of CS in FM patients were included in our review [59,72] (Table 1); neither article reported significantly higher SSP in FM patients compared to HC and chronic low back patients [59]. However, Van Oosterwijck et al. [72] found lower SSP in FM patients who had received an educational intervention on the physiology of pain. ...
... Two articles that used SSP as an indicator of CS in FM patients were included in our review [59,72] (Table 1); neither article reported significantly higher SSP in FM patients compared to HC and chronic low back patients [59]. However, Van Oosterwijck et al. [72] found lower SSP in FM patients who had received an educational intervention on the physiology of pain. ...
... The consensus was achieved either through discussing how the criteria were interpreted again or based on the input of the senior reviewer (G.A.R.d.P). The ROB evaluation revealed that 3 studies were of high quality [42,51,72], 3 were of moderate quality [46,54,59], and the reimaging 28 studies were of low quality. Details on the ROB assessments are shown in Table 2. ...
Article
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Introduction: The pathophysiology of fibromyalgia (FM) is related to central sensitisation (CS) to pain. Algometry allows assessing CS based on dynamic evoked pain. However, current algometry’s protocols require optimising, unifying and updating. Objectives: 1) identify the dynamic pain measures used most frequently to effectively assess CS processes in FM, and 2) consider the future of the algometry assessing CS in these patients. Methods: Cochrane Collaboration guidelines and PRISMA statements were followed. The proto- col was registered in PROSPERO database (ID: CRD42021270135). The selected articles were eval- uated using the Cochrane risk of bias (ROB) assessment tool. The PubMed, Scopus, and Web of Science databases were searched. Results: Thirty-four studies were selected, including measures such as temporal summation of pain (TSP), aftersensations (AS), spatial summation of pain (SSP), the noxious flexion reflex (NFR) threshold, conditioned pain modulation (CPM), cutaneous silent period (CuSP), and slowly repeated evoked pain (SREP); and evoked pain combined with neuroimaging. Each measure offered various advantages and limitations. According to ROB, 28 studies were of low quality, 3 of moderate quality, and 3 of high quality. Conclusions: Several pain indicators have been demonstrated to successfully examine CS involvement in FM in the last years. Algometry, especially when it involves diverse body sites and tissues, might provide further insight into (1) the evaluation of psychological factors known to influence pain experience, (2) new dynamic pain indicators, and (3) the simultaneous use of certain neuroimaging techniques. Further research clarifying the mechanisms underlying some of these measures, and homogenisation and optimisation of the algometry’s protocols, are needed.
... From this perspective, the reconceptualization of pain may provide opportunities for individuals to examine their thoughts, facilitate future behavioral change, and perhaps share their experience with others in a social context (Louw et al., 2020). Studies have found that individuals increased their knowledge of pain and improved their outcome scores when given the PNE information in both one-on-one and group settings across many languages (Barrenengoa-Cuadra et al., 2020;Cox, Louw, and Puentedura, 2017;Gallagher, McAuley, and Moseley, 2013;James, Thompson, Neumann, and Briffa, 2019;Louw et al., 2018;Louw, Zimney, O'Hotto, and Hilton, 2016;Meeus et al., 2010b;Orhan et al., 2021;Rufa, Beissner, and Dolphin, 2019;Simões, Andias, Simões, and Silva, 2022;Van Oosterwijck et al., 2013;Watson et al., 2019;Wijma et al., 2018). Knowledge of pain, however, does not necessarily correlate with reconceptualization. ...
... The overall lack of knowledge retention is consistent with findings that suggest students only retain 41% of material following a 15-minute lecture (Bradbury, 2016). Nevertheless, these scores for knowledge of pain are lower than other PNE studies in lay populations, where posttest accuracy has been reported between 57% and 72% (Louw et al., 2018;Meeus et al., 2010b;Van Oosterwijck et al., 2013). The lower posttest accuracy scores found in the current study may be, in part, be explained by the association between minority status and health literacy (Freedman, Kouri, West, and Keating, 2015;Turner et al., 2017). ...
... Similar to the adult learning principles of experiential learning and situated cognition, participants frequently noted the importance of reflection as it related to behavioral transformation (Merriam and Bierema, 2014). For example, participants reported meaningful lifestyle changes, such as decreased or delayed analgesic use, utilization of physical activity and other distractions when experiencing pain, and increased pain tolerance, all of which are consistent with previous literature (Van Oosterwijck et al., 2013). Of note, most of these comments were from a participant who personally experienced persistent pain supporting the relevance of PNE for her. ...
Article
Background: Chronic pain and pain catastrophization are growing problems across the United States, within the Hispanic-American population. Pain neuroscience education (PNE) changes pain knowledge and beliefs in many populations, but its impact on reconceptualization in people of Hispanic-American origin is unknown. Purpose: Explore the changes in pain knowledge in Hispanic-American individuals and the process involved in reconceptualization following a PNE lecture. Methods: Eight Hispanic-American adults participated in a mixed-methods exploratory study. The Revised Neurophysiology of Pain Questionnaire (R-NPQ) was completed before, immediately after, and eight months after an adapted PNE lecture. A focus group involving four participants discussed the impact of PNE. Transcripts were translated and theme coded, and a concept map was developed by consensus. Results: R-NPQ scores improved from 25.3% to 43.5% post-lecture, and the number of unsure responses decreased from 41.5% to 18.4%. At eight months, R-NPQ scores remained stable (44.2%) but unsure responses increased (28.9%). Themes that contributed to the process of change included cognitive dissonance, relevance of instruction, idea exchange through peer interaction, reflection, confidence, changed behaviors, and educational utility. Conclusion: While small improvements in knowledge and perception of pain appeared to occur with the PNE, knowledge remained low. Consideration of adult learning principles such as applicability, peer-interaction, the confrontation of beliefs, and reflection throughout PNE may enhance its impact. Future investigation should explore the efficacy of this intervention, when compared or combined with other techniques in the treatment of Hispanic-Americans experiencing persistent pain.
... NET can provide uniform factual information that can improve pain experience while allowing participants time to also consider their individual circumstances. NET has been effective in individual sessions [13,[20][21][22][23][24][25][26][27][28][29][30][31][32][33], group sessions [34][35][36][37][38][39][40][41][42][43][44], and a combination of individual and group sessions [45][46][47]50] and therefore lends itself to widespread use. While NET group sessions may be more affordable, it is also possible to develop short, cost-effective one-on-one sessions as NET has been delivered in sessions as short as 30 minutes [53,51]. ...
... As seen in Table 5, six studies evaluated NET as a treatment for fibromyalgia (FM), and studies vary in their results regarding efficacy. Two studies, one comparing NET with pain self-management education [29] and one comparing NET plus therapeutic exercise with therapeutic exercise alone [28] showed improved pain outcomes with NET compared with the control. In their study, Van Oosterwijck et al. [29] showed improved long-term pain [30] • Delivery: remotely, online self-learning • Format: video, survey self-assessments injury, and brain's pathways for generating pain can be unlearned scores and endogenous pain inhibition vs the control and improved physical functioning, general health perceptions, vitality, and mental health over time. ...
... Two studies, one comparing NET with pain self-management education [29] and one comparing NET plus therapeutic exercise with therapeutic exercise alone [28] showed improved pain outcomes with NET compared with the control. In their study, Van Oosterwijck et al. [29] showed improved long-term pain [30] • Delivery: remotely, online self-learning • Format: video, survey self-assessments injury, and brain's pathways for generating pain can be unlearned scores and endogenous pain inhibition vs the control and improved physical functioning, general health perceptions, vitality, and mental health over time. Similarly, the Ceballos-Laita et al. [28] showed decreased pain intensity after NET in the short term. ...
Article
Background: Neuroscience Education Therapy (NET) has been successfully used for numerous overlapping pain conditions, but few studies have investigated NET for migraine. Objective: We sought to (1) review the literature on NET used for the treatment of various pain conditions to assess how NET has been studied thus far and (2) recommend considerations for future research of NET for the treatment of migraine. Design/methods: Following the PRISMA guideline for scoping reviews (PRISMA-ScR) Co-author (TR), a Medical Librarian, searched the MEDLINE, PsychInfo, Embase & Cochrane Central Clinical Trials Registry databases for peer-reviewed articles describing NET to treat migraine and other chronic pain conditions. Each citation was reviewed by two trained independent reviewers. Conflicts were resolved through consensus. Results: Overall, a NET curriculum consists of the following topics: pain does not equate to injury, pain is generated in the brain, perception, genetics, reward systems, fear, brain plasticity, and placebo/nocebo effects. Delivered through individual, group, or a combination of individual and group sessions, NET treatments often incorporate exercise programs and/or components of other evidence-based behavioral treatments. NET has significantly reduced catastrophizing, kinesiophobia, pain intensity, and disability in overlapping pain conditions. In migraine-specific studies, when implemented together with traditional pharmacological treatments, NET has emerged as a promising therapy by reducing migraine days, pain intensity and duration, and acute medication intake. Conclusion: NET is an established treatment for pain conditions, and future research should focus on refining NET for migraine, examining delivery modality, dosage, components of other behavioral therapies to integrate, and migraine-specific NET curricula.
... [16][17][18] This therapeutic approach has been extensively investigated in various chronic pain conditions. [19][20][21][22][23][24][25][26][27][28][29][30][31][32] A recent systematic review 33 has supported the efficacy of PNE in the improvement of pain-related disability, pain catastrophizing, avoidance behaviour, and inactivity. It is important to point out that PNE seems even more effective when it is combined with 6 therapeutic exercise, gradual exposure techniques, or cognitive behavioural therapy (CBT). ...
... physical activity plus CBT) as an add-on of usual care for the management of FM 12,13,20,[31][32][33]41 . Overall, they have demonstrated to be effective therapeutic options, leading to improvements in mental health, well-being, and physical function 11,13,[18][19][20][21][22][23][24][25][26] . However, in most cases, the reported effect sizes ranged from small to moderate magnitudes. ...
... In short, using our multicomponent treatment as example, patients would be As stated above, this is the first study to demonstrate the effectiveness of a multicomponent treatment that specifically integrates PNE in patients with FM. There are many studies that support the individual effectiveness of each of the treatment components that constitute this multicomponent therapy 11,[13][14][15][18][19][20][21][22][23][24][25][26][27][63][64][65][66][67][68][69][70][71][72] . In spite of the complexity of integrating different ingredients, the present RCT was designed on the basis of a clear and 22 replicable methodology. ...
Article
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Methods. A randomised controlled trial was performed to evaluate the effectiveness of a 12-week multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioural therapy and mindfulness, in addition to treatment as usual, compared to treatment as usual only in patients with fibromyalgia (FM). A total of 272 patients were randomly assigned to either the multicomponent treatment (n= 135) or treatment as usual (n= 137). The multicomponent treatment (2h weekly sessions) was delivered in groups of 20 participants. Treatment as usual was mainly based on pharmacological treatment according to the predominant symptoms. Data on functional impairment (the Revised Fibromyalgia Impact Questionnaire, FIQR as primary outcome) were collected, as well as for pain, fatigue, kinesiophobia, physical function, anxiety, and depressive symptoms (secondary outcomes) at baseline, at 12 weeks and, for the multicomponent group only, at 6 and 9 months. An intention to treat approach was used to analyse between-group differences. We also analysed baseline differences between responders (> 20% FIQR reduction) and non-responders and computed the number needed to treat. Results. At post-treatment, significant between-group differences (p < .001) with a large effect size (Cohen’s d > 0.80) in favour of the multicomponent treatment were found in functional impairment, pain, kinesiophobia, and physical function, whilst differences with a moderate size effect (Cohen’s d > 0.50 and < 0.80) were found in fatigue, anxiety, and depressive symptoms. Non-responders scored higher on depressive symptoms than responders at baseline. The number needed to treat was 2 (95% CI 1.7 - 2.3). Conclusions. Compared to usual care, there was evidence of short-term (up to three months) positive effects of the multicomponent treatment for FM. Nevertheless, some methodological shortcomings (absence of follow-up in the control group and monitoring of treatment adherence, potential research allegiance, etc.) preclude robust conclusions regarding the proposed multicomponent program.
... Non-pharmacological strategies include interventions such as pain education, cognitive behavioral therapy (CBT), mindfulness, therapeutic physical exercise, among others, which aim primarily at alleviating symptoms and improving patients' quality of life (Macfarlane et al., 2017). More specifically, Pain Neuroscience Education (PNE) (Van Oosterwijck et al., 2013;Nijs et al., 2014;Amer-Cuenca et al., 2020) is aimed at changing patients' pain beliefs, emphasizing how overprotective behaviors can accentuate pain experience (Moseley and Butler, 2015). PNE has been found to be effective for reducing pain disability, catastrophizing, avoidance behaviors and physical inactivity in patients with FM (Malfliet et al., 2017). ...
... Mounting empirical evidence suggests that multicomponent approaches integrating at least therapeutic physical exercise and a psychological/educational intervention can be effective in individuals with FM (e.g., Van Wilgen et al., 2007;Castel et al., 2013;Thieme et al., 2017) and some authors propose that these multicomponent interventions should be the "gold standard" in FM (Rivera et al., 2006;Häuser et al., 2008;De Miquel et al., 2010;Macfarlane et al., 2017;Thieme et al., 2017). In this regard, a metanalysis exploring the efficacy of different pharmacological and non-pharmacological therapies on fibromyalgia symptoms (Papadopoulou et al., 2016) suggested that multidisciplinary treatments would be the most beneficial ones among non-pharmacological interventions for treating FM, since statistically significant improvements were found in all FM symptoms comprising OMERACT-10 response criteria (i.e., pain, sleep, function, fatigue, anxiety, depression, cognition). ...
Article
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Introduction: The On&Out study is aimed at assessing the effectiveness, cost-utility and physiological underpinnings of the FIBROWALK multicomponent intervention conducted in two different settings: online (FIBRO-On) or outdoors (FIBRO-Out). Both interventions have proved to be efficacious in the short-term but there is no study assessing their comparative effectiveness nor their long-term effects. For the first time, this study will also evaluate the cost-utility (6-month time-horizon) and the effects on immune-inflammatory biomarkers and Brain-Derived Neurotrophic Factor (BDNF) levels of both interventions. The objectives of this 6-month, randomized, controlled trial (RCT) are 1) to examine the effectiveness and cost-utility of adding FIBRO-On or FIBRO-Out to Treatment-As-Usual (TAU) for individuals with fibromyalgia (FM); 2) to identify pre–post differences in blood biomarker levels in the three study arms and 3) to analyze the role of process variables as mediators of 6-month follow-up clinical outcomes. Methods and analysis: Participants will be 225 individuals with FM recruited at Vall d’Hebron University Hospital (Barcelona, Spain), randomly allocated to one of the three study arms: TAU vs. TAU + FIBRO-On vs. TAU + FIBRO-Out. A comprehensive assessment to collect functional impairment, pain, fatigue, depressive and anxiety symptoms, perceived stress, central sensitization, physical function, sleep quality, perceived cognitive dysfunction, kinesiophobia, pain catastrophizing, psychological inflexibility in pain and pain knowledge will be conducted pre-intervention, at 6 weeks, post-intervention (12 weeks), and at 6-month follow-up. Changes in immune-inflammatory biomarkers [i.e., IL-6, CXCL8, IL-17A, IL-4, IL-10, and high-sensitivity C-reactive protein (hs-CRP)] and Brain-Derived Neurotrophic Factor will be evaluated in 40 participants in each treatment arm (total n = 120) at pre- and post-treatment. Quality of life and direct and indirect costs will be evaluated at baseline and at 6-month follow-up. Linear mixed-effects regression models using restricted maximum likelihood, mediational models and a full economic evaluation applying bootstrapping techniques, acceptability curves and sensitivity analyses will be computed. Ethics and dissemination: This study has been approved by the Ethics Committee of the Vall d’Hebron Institute of Research. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media and various community engagement activities. Trial registration number NCT05377567 ( clinicaltrials.gov ).
... The results obtained in our study are comparable to the best results reported in published controlled studies that used various interventions based on PNE [26,34,39]. Van Ittersum et al. [26] concluded that supplying written information on the physiology of pain, followed by a motivational telephone call to resolve doubts, was not effective in patients with FM in terms of modifying the impact of pain in daily life, of improving feelings related to pain (catastrophizing) nor in perceptions regarding the condition. ...
... Van Ittersum et al. [26] concluded that supplying written information on the physiology of pain, followed by a motivational telephone call to resolve doubts, was not effective in patients with FM in terms of modifying the impact of pain in daily life, of improving feelings related to pain (catastrophizing) nor in perceptions regarding the condition. In the study by van Oosterwijck et al. [39], an intervention consisting of 2 individual PNE sessions, each of 30 min, achieved a reduced degree of anxiety in the short term and longer-term improvements in vitality, functionality, mental health and in the general perception of health; however, the pressure pain thresholds remained unchanged. The EFFIGACT study, the only one carried out in PC, showed that the group that received the PNE intervention (8 sessions of 2.5 h each with groups of 10 to 15 patients) experienced a greater increase in their overall functional state than the group treated with drugs or the CG; they also reported improvements in the pain catastrophizing scale, acceptance of pain, subjective pain, quality of life, and anxiety and depression, with mediumsized effects in a majority of cases. ...
Article
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Background Very positive effects have been described in the application of pain neuroscience education (PNE) to chronic pain and migraine. However, there are few data on the applicability of this therapeutic approach in actual clinical practice in a primary care (PC) setting. The aim of this study was to explore the efficacy in fibromyalgia (FM) of an intervention based on PNE and exercise compared to treatment as usual (TAU). Methods Pragmatic nonrandomised controlled trial set in 5 healthcare centres and one physiotherapy centre in PC. Fifty-three women with FM (2010 American College of Rheumatology Diagnostic Criteria for Fibromyalgia) were studied, 35 in the intervention group (IG) and 18 in the control group (CG). The women in the IG were interviewed individually and then received 6 weekly sessions plus one review session (1 month later): those in the CG received their TAU. The subject assignation to the CG or the IG was determined according to their availability to attend the sessions. They all filled in several questionnaires (prior to and 1 year after the intervention) to evaluate the impact of FM in their daily lives, catastrophism, anxiety and depression, severity and impact of pain in daily personal performance and functional capacity. Results The reductions (improvements) in the scores of all tests (baseline-final) were greater in the IG (p < 0.05) when adjusted for age and baseline values, with moderate or high effect size. After 1 year, 20% (CI − 1 to 42%) more women in the IG, compared to the CG, had a FIQ score < 39 (mild functional impairment). 17/38 (49%) women in the IG no longer met FM criteria at the end of follow-up. Conclusions An intervention based on PNE and exercise in patients with FM is feasible and seems effective in PC. Trial registration The study was retrospectively registered at ClinicalTrials.gov (Trial Registration NCT04539171), on 04/09/2020.
... Previous studies of PNE have focused on patients with chronic low back pain [13,19], chronic fatigue syndromes [15], fibromyalgia [20], both neck and low back pain [21] and chronic whiplash pain (14), as well as those undergoing surgery for lumbar radiculopathy [22]; however, studies patients with idiopathic chronic neck pain are lacking. Although neck pain is the second most common type of chronic pain, studies of PNE in patients with neck pain have been limited to patients with chronic whiplash-related neck disorders [21]. ...
... Our results showed that education-only approaches of PNE could not change pain intensity, which is in accordance the the results reported in a systematic review [12]. Previous studies examining PNE combined with active or passive therapy [13,15,20,34] have reported an improvement in pain, which was not observed in our study. It should be noted that in these previous studies, the study population comprised patients with neck pain from whiplash or patient populations with different musculoskeletal pain, in contrast to our study population. ...
Article
Introduction: Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the bio psychosocial nature of chronic musculoskeletal pain, an educational approach based on the bio psychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID 19. Methods: In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 9 2 variance analysis (treatment group 9 time) with a mixed-model design was applied to statistically analyze the data. Results: No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen’s d = 0.17, 95% confidence interval [CI] - 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen’s d = 0.34, 95% CI 0.11–0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%;). Conclusion: In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown. Keywords: Nonspecific neck pain; Pain; Kinesiophobia; Pain neuroscience education
... Previous studies of PNE have focused on patients with chronic low back pain [13,19], chronic fatigue syndromes [15], fibromyalgia [20], both neck and low back pain [21] and chronic whiplash pain (14), as well as those undergoing surgery for lumbar radiculopathy [22]; however, studies patients with idiopathic chronic neck pain are lacking. Although neck pain is the second most common type of chronic pain, studies of PNE in patients with neck pain have been limited to patients with chronic whiplash-related neck disorders [21]. ...
... Our results showed that education-only approaches of PNE could not change pain intensity, which is in accordance the the results reported in a systematic review [12]. Previous studies examining PNE combined with active or passive therapy [13,15,20,34] have reported an improvement in pain, which was not observed in our study. It should be noted that in these previous studies, the study population comprised patients with neck pain from whiplash or patient populations with different musculoskeletal pain, in contrast to our study population. ...
Article
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Introduction Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. Methods In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. Results No significant change in pain (P = 0.23) was observed between the two groups (P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] − 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant (P = 0.04, Cohen's d = 0.34, 95% CI 0.11–0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable (P = 0.04; 14.28%↓). Conclusion In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.
... Current therapeutic strategies in FM usually combine pharmacological and nonpharmacological approaches [10][11][12][13], and multicomponent non-pharmacological treatments are currently considered the gold standard [12,[14][15][16][17]. Regarding therapy components proved to be effective in FM, Pain Neuroscience Education (PNE) [18][19][20][21][22][23][24][25][26][27][28] is aimed at changing patients' pain beliefs, emphasizing how overprotective behaviors can modulate pain experience [29][30][31], and it has been found to be effective for reducing pain disability, catastrophizing, avoidance behaviors and physical inactivity in patients with FM [32]. On the other hand, Cognitive Behavioral Therapy (CBT) and therapeutic exercise are also core pillars of intervention in FM [33][34][35], and combining both has been seen to be particularly effective at treating several FM symptoms [36][37][38] (e.g., relieving pain, fatigue, depression, and improving psychological well-being and physical functioning [12,33]). ...
... Beyond therapeutic exercise and CBT, an important strength of the FIBROWALK protocol is the addition of PNE and mindfulness training, which constitute, respectively, a significant change of perspective regarding the classical pain education and the CBT focus on changing problematic thoughts. In this regard, PNE is aimed at educating patients on the mechanisms behind chronic pain, highlighting that any credible evidence of danger or safety in body tissues can increase or decrease pain perception, respectively [22], and has been found to be effective in patients with FM [18][19][20][21][22][23][24][25][26][27][28]. It is noteworthy that PNE seems even more effective when it is combined with therapeutic exercise, gradual exposure techniques, and CBT [24,70], all of which are integrated elements in the FIBROWALK program. ...
Article
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Abstract: FIBROWALK is a multicomponent program including Pain Neuroscience education, therapeutic exercise, cognitive-behavioral therapy and mindfulness training which, recently, has been found to be effective in patients with fibromyalgia (FM). This RCT started before the COVID-19 pandemic and was moved to virtual format (i.e., online videos) when the lockdown was declared in Spain. This study is aimed to evaluate the efficacy of a virtual FIBROWALK compared to treatment-as-usual (TAU) in patients with FM during the first state of alarm in Spain. A total of 151 patients with FM were randomized into two study arms: FIBROWALK plus TAU vs. TAU alone. The primary outcome was functional impairment. Secondary outcomes were kinesiophobia, anxiety and depressive symptomatology, and physical functioning. Differences between groups at post-treatment assessment were analyzed using intention to treat (ITT) and completer approaches. Baseline differences between clinical responders and non-responders were also explored. Statistically significant improvements with small-to-moderate effect sizes were observed in FIBROWALK+TAU vs. TAU regarding functional impairment and most secondary outcomes. In our study, the NNT was 5 which, albeit modestly, was indicative of an efficacious intervention. The results of this proof-of-concept RCT preliminary supports the efficacy of virtual FIBROWALK in patients with FM during Spanish COVID-19 lockdown. Keywords: Fibromyalgia; multicomponent treatment; pain neuroscience education; therapeutic exercise; cognitive behavioral therapy; mindfulness; randomized controlled trial; COVID-19; online treatment; teletherapy.
... Adult studies (ages 18-65) have shown NPQ mean improvements after a PNE session to typically range between 25 and 30%. 19,27,34 In the previous middle school PNE studies the mean increase in NPQ was 28%. 21,35 • Fear Avoidance Beliefs of Physical Activity: To assess fear-avoidance beliefs we used the Fear Avoidance Beliefs Questionnaire -FABQ. ...
... Overall, the PNE sessions yielded in significant improvement in knowledge of pain, but only yielded an 11% increase in comparison to typical increases of 25-30% in adult populations. 19,27,34 It is however, important to recognize that the mean pre-PNE score for the NPQ in the older adults was 43.5% compared to the original NPQ study by Moseley's score of 29%. 27 The post-PNE score of 54.7% was comparable to Moseley's 61%, albeit that session was a 3-hour PNE session. ...
Article
Aims To assess if Pain Neuroscience Education (PNE) delivered to older adults can positively influence pain knowledge and pain beliefs. Methods A total of 55 older adults attended a 30-minute PNE lecture. The primary outcome measures of pain knowledge, fear avoidance, beliefs regarding pain and aging as well as self-reported pain were obtained both pre- and post-lecture. Results Significant improvement in knowledge was found with a mean score on the neurophysiology of pain questionnaire test improving by 11.07% from pre to post-test (p = 0.002). A greater shift in knowledge was observed in the older adult group (70 and above) compared to the younger group (50–69). Conclusions A brief PNE lecture to older adults positively influences pain knowledge, and beliefs regarding pain and aging. This study indicates that PNE can be understood by older adults and may be a viable non-pharmacological treatment for older adults experiencing pain.
... This subgroup with involvement of central mechanisms is often referred to as patients with a predominance of nociplastic pain. 62 The growing evidence that educating patients positively affects central pain processing (e.g., increased pain thresholds 63,64 and conditioned pain modulation 64,65 ) creates an exciting window for MEP-rehabilitation. We hope that this review will encourage researchers to gain insight into the role of pain education when addressing MEP in patients with musculoskeletal pain and, perhaps even more important, in patients with a predominance of nociplastic pain. ...
Article
Background A growing body of evidence has demonstrated the importance of implementing movement-evoked pain in conventional pain assessments, with a significant role for psychological factors being suggested. Whether or not to include these factors in the assessment of movement-evoked pain has not yet been determined. Objectives The aim of this systematic review is to explore the association between psychological factors and movement-evoked pain scores in people with musculoskeletal pain. Methods For this systematic review with meta-analysis, four electronic databases (PubMed, Medline, WOS, and Scopus) were searched. Cross-sectional studies, longitudinal cohort studies, and randomized controlled trials investigating the association between movement-evoked pain and psychological factors in adults with musculoskeletal pain were considered. Meta-analysis was conducted for outcomes with homogeneous data from at least 2 studies. Fischer-Z transformations were used as the measure of effect. Quality of evidence was assessed using the National Institutes of Health's Quality assessment tool for observational cohort and cross-sectional studies and Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Results Meta-analyses and grading the quality of evidence revealed moderate evidence for a relation between movement-evoked pain and depressive symptoms (Fisher-z=0.27; 95%CI: 0.17, 0.36; 5 studies (n=440)), pain-related fear (Fisher-z=0.35; 95%CI: 0.26, 0.44; 6 studies (n=492)), and pain catastrophizing (Fisher-z=0.47; 95%CI: 0.36, 0.58; 4 studies (n=312)) in people with musculoskeletal pain. Conclusions Movement-evoked pain is weakly to moderately associated to depressive symptoms, pain-related fear, and pain catastrophizing in people with musculoskeletal pain.
... Evidence in children and adolescents in clinical 43,44 and nonclinical [45][46][47][48] settings shows that PSE results in increased pain knowledge, 43,[45][46][47][48][55][56][57] more functional pain beliefs, 46,56,57 less catastrophic worry about pain, 58 less pain-related fear, 44 less functional disability, 44 less medication use, 45 higher pain thresholds, 44,48 higher school attendance, 45 and decreased fear of physical activity. 56 There is less evidence that PSE for both adults and children results in reduced pain intensity, 43,44,59 pressure pain thresholds, 60,61 or anxiety. 43,59 Table 1 provides an overview of intervention studies using PSE for children and adolescents. ...
Article
Pain in children living with and beyond cancer is understudied and undertreated. Pain science education (PSE) is a conceptual change strategy facilitating patients’ understanding of the biopsychosocial aspects of pain. Preliminary studies on the adaptation of PSE interventions to adults with and beyond cancer provide a foundation for pediatric research. PSE could help childhood cancer survivors experiencing persistent pain and pain‐related worry after active treatment. PSE may also help children receiving cancer treatment, providing them with a foundation of adaptive pain beliefs and cognitions, and preparing them for procedural and treatment‐related pain. We direct this paper toward pediatric oncology clinicians, policy makers, and researchers working with children living with and beyond cancer. We aim to (a) identify challenges in adapting PSE for children living with and beyond cancer, (b) offer possible solutions, and (c) propose research questions to guide the implementation of PSE for children living with and beyond cancer.
... Other studies began to show positive effects of interventions based on health education, such as the study by Van Oosterwijck et al. [55] in Ixelles (Belgium), which indicated that this approach appeared to be a useful component in the treatment of patients with FM, as it showed improved health status and long-term inhibition of endogenous pain. However, the improvements were minor, and several limitations persisted. ...
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Health education is one of the main items to enable the promotion of health for individuals with fibromyalgia (FM) in Primary Health Care (PHC) in Brazil. The purpose of this study was to validate a multidisciplinary educational health promotion program called Amigos de Fibro (Fibro Friends) for individuals with FM. Methodological research involving 23 health professionals (expert judges) and 45 individuals with FM (target audience) used an instrument to assess the objectives, proposed themes and initiatives, relevance, writing style, and structure of the program through the Delphi technique. The content validity index (CVI) ≥ 0.78 and coefficient kappa ≥ 0.61 were used for data analysis. All 25 items evaluated in both groups presented considerable minimum CVI by CVI and the kappa coefficient. In the global evaluation of Amigos de Fibro, the CVI of the specialist judges was 0.90, while the values of the target audience judges were 0.95. The kappa coefficient of the expert judges was 0.90 and that of the target audience judges was 0.85. Amigos de Fibro, a light technology in health, was considered with adequate content validity and internal consistency and is, therefore, valid in the use by health professionals with the target audience in PHC, making it possible for them to act as health-promoting agents.
... Adding PNE to conventional treatment has been shown to improve the levels of pain intensity, pain catastrophizing, kinesiophobia and disability in patients with chronic pain (Watson et al., 2019). Additionally, scientific evidence recommends the use of PNE in different conditions of chronic pain such as: non-operative management of low back pain (Moseley, Nicholas, and Hodges, 2004;Pardo et al., 2018;Ryan, Gray, Newton, and Granat, 2010); cervical pain (Javdaneh, Saeterbakken, Shams, and Barati, 2021); and fibromyalgia (Van Oosterwijck et al., 2013) as well as in the preoperative setting for patients undergoing total knee arthroplasty (Louw et al., 2019b) and carpal tunnel surgery (Núñez-Cortés et al., 2019). Despite this, there are currently no studies of postoperative PNE in patients with shoulder pain. ...
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Objective: To compare the effectiveness of pain neuroscience education (PNE) versus biomedical education (BME) in a rehabilitation program following arthroscopic rotator cuff repair (ARCR) in patients with chronic shoulder pain. Methods: Twenty-nine patients who participated in a rehabilitation program were randomly assigned to either an experimental PNE group (N = 16) or a control BME group (N = 13). Measurements included pain intensity at rest and in movement, pain catastrophizing, kinesiophobia, disability and health-related quality of life (HRQoL). Outcomes were evaluated at baseline and at 4 and 8 weeks after the intervention. Results: A main effect for time was observed for: intensity of pain at rest (p < .01); pain with movement (p < .01); pain catastrophizing (p < .01); kinesiophobia (p < .01); disability (p < .01); and HRQoL (p < .01). No group interactions were significant for any variable, except for pain with movement, which favored the PNE group (p = .03). Large effect sizes (ranging from d = 0.79 to d = 2.65) were found for both interventions in all outcomes. Conclusion: A rehabilitation program including either PNE or BME are equally effective in improving rest pain, pain catastrophizing, kinesiophobia, disability, and HRQoL in patients after ARCR, except for pain at movement in favor of the PNE group. The inclusion of PNE in the rehabilitation program appears to lead to clinically meaningful improvements in pain at rest in short term when treating patients with ARCR.
... Several studies have demonstrated that PNE is effective method for pain relief, improving functions, changing pain beliefs and attitudes, decreasing kinesiophobia, and reducing healthcare expenditure in patients with several chronic pain disorders. [35][36][37] It has been advocated that the action mechanism for PNE is related to function of brain-orchestrated nociceptive inhibition. [38] By understanding of pain well, the threat of pain would decrease, leading to more effective pain coping strategies. ...
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Objectives: This study aims to investigate the postoperative short-term effectiveness of preoperative pain neurophysiology education on pain severity, kinesiophobia, and disability in patients undergoing lumbar surgery for radiculopathy. Patients and methods: Between April 2019 and August 2019, a total of 41 patients (22 males, 19 females; mean age 52.1±9.5 years; range, 37 to 64 years) scheduled for lumbar radiculopathy surgery were randomized to receive either preoperative routine education only (control group, n=20) or a 70-min pain neurophysiology education in addition to preoperative routine education (intervention group, n=21). The patients were evaluated for the following outcomes prior to surgery (baseline) and at 12 weeks after surgery: low back pain and leg pain using Numeric Pain Rating Scale, disability using Oswestry Disability Index), and kinesiophobia using Tampa Scale for Kinesiophobia. Results: There were no statistically significant differences in low back pain (p=0.121), leg pain (p=0.142), and the length of stay hospital (p=0.110) between the groups. However, the interaction effects of intervention group were superior to control group regarding disability (p=0.042) and kinesiophobia (p<0.001). Conclusion: The addition of pain neurophysiology education to routine education following lumbar radiculopathy surgery yields significant improvements for disability and kinesiophobia, although no additional benefits is seen regarding the pain severity and length of stay in hospital in the short-term.
... Ostensibly, these effects could be minimized by balancing discussion of PEM with other types of education about pain and exercise. For instance, Van Oosterwijck and colleagues randomized FM patients to receive a pain neurophysiology education intervention or a control condition involving pacing self-management education and observed improved pressure pain thresholds and pain ratings in the experimental group (66). The study by Van ...
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Objective: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) and Fibromyalgia (FM) are two debilitating, moderately comorbid illnesses in which chronic musculoskeletal pain symptoms are prevalent. These individuals can experience post-exertional malaise (PEM), a phenomenon where symptom severity is worsened 24hr or longer following physical stress, but the pain-related component of PEM is not well characterized. Design: Systematic review and meta-analysis. Methods: Case-control studies involving adults with ME/CFS or FM and measuring pain symptoms before and after exposure to a standardized aerobic exercise test were included. Hedges' d effect sizes were aggregated using random effects models and potential moderators were explored with meta-regression analysis. Results were adjusted for nesting effects using three-level modeling. Results: Forty-five effects were extracted from 15 studies involving 306 patients and 292 healthy controls. After adjusting for nesting effects, we observed a small-to-moderate effect indicating higher post-exercise pain in patients than controls (Hedges' d=0.42; 95% CI: 0.16, 0.67). The mean effect was significantly moderated by pain measurement timepoint (b = -0.19, z = -2.57, P = 0.01) such that studies measuring pain 8-72hr post-exercise showed larger effects (d = 0.71, 95% CI = 0.28-1.14) than those measuring pain 0-2hr post-exercise (d = 0.32, 95% CI = 0.10-0.53). Conclusions: People with ME/CFS and FM experience small-to-moderate increases in pain severity following exercise which confirms pain as a component of PEM and emphasizes its debilitating impact in ME/CFS and FM. Future directions include determining mechanisms of pain-related PEM and developing exercise prescriptions that minimize symptom exacerbation in these illnesses.
... Due to the efficacy of PNE in chronic pain management [17][18][19], there is a need for further internationalisation of its application. Presently, PNE is well established (developed and validated) among Caucasians [12,15,[20][21][22][23], and access to it by other world languages and cultural groups is still lacking. More importantly, variations in culture, socioeconomic status, gender issues, and literacy levels have to be considered when developing educational tools for any population [24]. ...
Article
Purpose To pilot feasibility and assess preliminary effectiveness of standard and culture-sensitive Pain Neuroscience Education (PNE) among Hausa-speaking patients with Chronic Neck Pain (CNP). Methods Adverts (online & clinic-based) were used to recruit Hausa-speaking patients with nonspecific CNP in Kano, Nigeria. Selected participants were randomized to culture-sensitive PNE (CSPNE), standard PNE (PNE), or control groups. Each group received bi-weekly sessions of exercise therapy for 6 weeks. Two sessions of PNE plus a home-based session were administered before exercise therapy in the PNE groups. Primary (pain-intensity and disability) and secondary (pain-knowledge, pain catastrophizing, and quality of life) outcomes were measured. The study was pre-registered (PACTR201902788269426). Results Fifty-three (out of 64) participants met the inclusion criteria. The majority of them were recruited through radio adverts (83%). Interventions were successfully administered and data collection was completed for the participants. About 15% and 17% drop-out rate was recorded before intervention (post-randomization) and during follow-up, respectively. Main results indicated that significant within-group improvements in disability and pain knowledge scores were found in favor of the PNE groups. Conclusion Culture-sensitive and standard PNE plus exercise therapy are feasible for Hausa patients with CNP, and current findings indicate support for reducing disability and increasing pain knowledge among them. • Implications for rehabilitation • Both standard PNE and culture-sensitive PNE are feasible for administration as interventions for Hausa-speaking patients with CNP. • Radio adverts may be necessary for patients recruitment in addition to specialists’ referrals. • Culturally sensitive PNE materials may be more desirable as an intervention option due to the low literacy level among the Hausa population.
... 1,10,11 PNE has been found to be an effective intervention to improve psychosocial factors, function, and pain outcomes in various populations with pain and especially in those showing symptoms of central sensitization. [12][13][14][15][16][17][18][19][20][21] One of the first studies investigating preoperative PNE in people undergoing TKA was the original analysis of the data used for this secondary analysis. 10 In general, research on perioperative PNE in people with KOA is still in its infancy, but the limited findings are promising. ...
Article
Objective: This explorative study investigates the moderating effect of sex and baseline pain characteristics on the effectiveness of preoperative pain neuroscience education (PNE) plus knee joint mobilization versus biomedical education plus knee joint mobilization in patients who have knee osteoarthritis and are scheduled to undergo total knee arthroplasty (TKA). Methods: After baseline assessment of self-reported questionnaires (pain intensity, disability, symptoms of central sensitization and pain cognitions) and quantitative sensory testing, 44 participants with knee osteoarthritis were randomized into the PNE plus knee joint mobilization or biomedical education plus knee joint mobilization group. The questionnaires were retaken directly after and 1 month after 4 sessions of treatment, and at 3 months after surgery. Based on baseline quantitative sensory testing results, the sample was subdivided into a high (showing high experimental pain levels and low pressure pain thresholds) and low pain cluster using principal components analysis and cluster analysis. Therapy effects over time were evaluated using 3-way analysis of variance, with time as the within factor and treatment, sex and baseline pain cluster as between factors. Results: Women benefited significantly more from the PNE intervention compared to the control intervention in terms of self-reported symptoms of central sensitization. For both pain clusters, differences in therapeutic effects concerning pain intensity and pain cognitions were found, with higher superiority of the PNE intervention in the high pain cluster subgroup compared to the low pain cluster. Conclusion: Based on these explorative analyses it can be concluded that sex and preoperative pain measures may influence the effectiveness of preoperative PNE for some specific outcome measures in people scheduled to undergo TKA. Impact: Although further research on this topic is needed, the potential influence of sex and preoperative pain measures on the effectiveness of preoperative PNE should be considered when implementing this intervention in people undergoing TKA.
... In non-cancer pain populations, PNE is welcomed very positively (25,59) and has proven to be effective in decreasing pain intensity, increasing physical performance, and improving quality of life, as well as pain coping strategies (25,(59)(60)(61)(62)(63)(64)(65)(66). Taken together and as illustrated in Figure 2, PNE appears to be an appropriate intervention for addressing the consequences of perceived injustice. ...
Article
Background: The presence of pain decreases survival rates in cancer. Pain management in clinical settings is often suboptimal and secondary to other cancer-related treatments, leaving many people undertreated. Opioid use is associated with side effects and decreased survival rate in cancer patients. Hence, there is an urgent need for considering factors such as perceived injustice that sustain post-cancer pain and trigger a behavioral pattern associated with opioid use. Injustice beliefs represent a maladaptive pattern of cognitive appraisal that may be a salient target for improving pain-related coping in these patients. Perceived injustice is associated with increased opioid prescription and prospectively predicted opioid use at 1-year follow-up, urging the need for targeted interventions to diminish perceived injustice. Objectives: Explain the importance of screening for perceived injustice in patients with pain following cancer treatment, its potential relevance for opioid abuse, and its potential impact on the management of pain following cancer. Also, prove clinicians with a clinical guide for an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions to account for perceived injustice in patients having pain following cancer. Study design: A narrative review, perspective and treatment manual. Setting: Several universities, a university of applied science department, a university hospital, and a private clinic (i.e., transdisciplinary pain treatment center). Methods: Patients were cancer survivors with pain. Intervention included modified pain neuroscience education, motivational interviewing, and acceptance-based interventions. Measurements were taken through the Injustice Experience Questionnaire (IEQ). Results: The IEQ can be used to assess perceived injustice in a valid way. Education about pain, including discussing perceived injustice, should be the first part of the management of pain in cancer survivors. In order to obtain the often-required behavioral change towards a more adaptive lifestyle, motivational interviewing can be used. To thoroughly tackle perceived injustice in patients having pain following cancer, special emphasis should be given to the individual reasons patients identify for experiencing (continued) pain and related symptoms. Pain acceptance should also be thoroughly addressed. Limitations: Clinical trials exploring the benefits, including cost-effectiveness, of such a multimodal approach in patients with pain following cancer treatment are needed. Conclusions: In light of its potential relevance for opioid abuse and potential impact on conservative management strategies, clinicians are advised to screen for perceived injustice in patients with pain following cancer treatment. Therapeutic targeting of perceived injustice can be done through an approach comprising of modified pain neuroscience education, motivational interviewing, and acceptance-based interventions.
... Ostensibly, these effects could be minimized by balancing discussion of PEM with other types of education about pain and exercise. For instance, Van Oosterwijck and colleagues randomized FM patients to receive a pain neurophysiology education intervention or a control condition involving pacing self-management education and observed improved pressure pain thresholds and pain ratings in the experimental group (66). The study by Van ...
... It has shifted the focus of pain education away from a biomedical account of local causes of pain towards a neuroscientific account of nervous system processing, including at a brain level [16]. However, despite some success in improving shortterm pain severity and disability, evidence supporting PNE efficacy is mixed [16][17][18][19]. Systematic reviews show small effect sizes [20,21], often equivalent to physiotherapy alone [19]. ...
Article
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Objectives: A fundamental principle of pain management is educating patients on their pain using current neuroscience. However, current pain neurophysiology education (PNE) interventions show variable success in improving pain outcomes, and may be difficult to integrate with existing understanding of pain. This study aimed to investigate how people with chronic pain understand their pain, using qualitative exploration of their conceptualisations of pain, and how this understanding accommodated, or resisted, the messages of PNE. Methods: Twelve UK adults with chronic pain were recruited through advertisements on online pain networks. Semi-structured interviews were conducted remotely, with responses elicited using the Grid Elaboration Method (GEM) and then a PNE article. Participants' grid elaborations and responses to PNE were analysed using thematic analysis (TA). Results: Three main themes were extracted from participants' grid elaborations: communicating pain, explaining pain and living with pain. These themes incorporated varied, inconsistent sub-themes: of pain as simultaneously experiential and conceptual; in the body and in the mind; diagnosable and inexplicable; manageable and insuperable. Generalised, meta-level agreement was identified in participants' PNE responses, but with doubts about its practical value. Conclusions: This study shows that people understand pain through inconsistent experiential models that may resist attempts at conceptual integration. Participants' elaborations showed diverse and dissonant conceptualisations, with experiential themes of restricted living; assault on the self; pursuit of understanding pain and abandonment of that pursuit. Responses, although unexpectedly compatible with PNE, suggested that PNE was perceived as intellectually engaging but practically inadequate. Experiential disconfirmation may be required for behavioural change inhibited by embedded fears and aversive experiences. Ethical committee number: UCL REC# 17833/003.
... In relation to patient education from the point of view of multidisciplinary treatment, we can find some previous studies that report that this education associated with other types of treatments such as physical activity would provide very beneficial results [14][15][16]. More specifically, health education programs could modify the perception of quality of life and improve pain [17], in addition to improving health status and inhibiting endogenous pain in the long term [18]. ...
Article
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Introduction: Fibromyalgia (FM) translates into a reduction in the quality of life of people who suffer from it, being a chronic disease of unknown etiology. One of the most widespread treatments includes the combination of patient education, along with other components. At the educational level, the Fibromyalgia Knowledge Questionnaire (FKQ) is a tool that assesses knowledge of fibromyalgia. Objective: To obtain the translation and cultural adaptation of the FKQ questionnaire into Spanish, as well as its readability, in addition to knowing the relationship between knowledge of the disease and the level of disability. Method: In phase one, a translation-back translation and an evaluation of the readability of the questionnaire was carried out from INFLESZ, while in phase two, the questionnaire was passed to women with FM to detect their knowledge of the disease. A total of 49 women participated, with a mean age of 54.48 years. Results: The Spanish version of the FKQ questionnaire was rated by the participants in all its items as "clear and understandable". The readability obtained by the questionnaire was similar to its original version, with both totals being in the "normal" range, following the INFLESZ ranges. Regarding the patients' knowledge about FM, the component in which the highest score was obtained was physical activity (80% correct), while the one that obtained the worst score was knowledge about medication (50% correct). In addition, an inverse correlation was obtained between the FKQ and the FIQ (Fibromyalgia Impact Questionnaire) (r = -0.438; p < 0.01). Conclusions: The FKQ has been translated and culturally adapted, obtaining a correct understanding by the participants, as well as a degree of readability similar to the original questionnaire. Furthermore, it was obtained that, the lower the level of knowledge of the sick person, the greater the disability.
... Specifically, related to patient education, previous studies on the efficacy of linking information/education on FM in isolation to a noticeable improvement in FM can be hardly found. Nevertheless, Koca, et al. [15] state that patients' knowledge about FM could contributes to the control of disease and other studies have reported that health education programmes could modify the perception of quality of life and improve pain relief, as well as decrease dependence on health services [16], or that education in pain physiology seems to improve health status and long-term endogenous pain inhibition [17]. However, in most studies, information/education is approached from a multidisciplinary point of view, i.e., it is associated with other types of treatment such as physical activity, with very beneficial results [18][19][20]. ...
Article
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Introduction: Fibromyalgia (FM) affects 2.40% of the Spanish population. The most widespread treatment has been the combination of patient education, pain coping strategies and exercise. With regard to patient education, there are few previous studies on the efficacy of relating FM education in isolation with an improvement in FM, although there are some studies that report that health education programs could modify the perception of quality of life and improve pain. Objectives: the aim was to find out the level of knowledge about FM among patients in Extremadura, to explore the relationship between knowledge of FM and Health-Related Quality of Life (HRQoL) and to analyze the relationship between knowledge of physical activity in FM and the practice of physical activity. Methods: A single-measure cross-sectional study was carried out with 121 women with a mean age of 55.06 (±9.93) years. The following questionnaires were used: Fibromyalgia Knowledge Questionnaire (FKQ); SF12v2 (Short-Form Health Survey); and EURO-QOL-5D-5L (EQ-5D-5L). Results: regarding the level of knowledge of the participants about FM, it was found that 10% had a low knowledge, 49% medium and 41% high. In relation to the associations between the level of knowledge and HRQoL, a weak correlation between EQ-5D-5L and the FKQ in the domain of physical activity (r = 0.243) were found. Conclusions: it can be concluded that the level of knowledge about FM of the patients from Extremadura was medium-high and that there is a direct weak relationship between knowledge about physical activity in FM and HRQoL. However, no association was found between knowledge of physical activity in FM and the practice of physical activity.
... The development and use of PNE is well-established among Caucasians [9,[13][14][15][16][17]. However, its access in many other world languages and cultures is lacking. ...
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This study aimed to develop culturally sensitive pain neuroscience education (PNE) materials for Hausa speaking patients with chronic spinal pain (CSP). PNE is a program of teaching patients about pain that has gained considerable attention in research and is increasingly used during physical therapy for patients with chronic pain. It helps in decreasing pain, disability, fear-avoidance, pain catastrophization, movement restriction, and health care utilization among patients with chronic pain. However, existing PNE materials and their application are limited to few languages and cultural inclinations. Due to the variations in pain perceptions, beliefs, and related outcomes among different population groups, culture-sensitive PNE materials addressing these outcomes are warranted. A focus-group discussion comprising 4 experts was used to adapt and develop preliminary PNE materials. Thereafter, an internet-based 3-round modified Delphi-study involving 22 experts ensued. Experts' consensus/recommendations concerning the content were used in modifying the PNE materials. Consensus was predefined as ≥75% level of (dis)agreement. Eighteen experts completed the Delphi rounds. Nineteen, 18 and 18 experts participated in rounds 1, 2 and 3 respectively, representing 86%, 94% and 100% participation rate respectively. Consensus agreement was reached in every round and content of the materials, including drawings, examples, figures and metaphors were adapted following the experts' suggestions. We therefore concluded that, culture-sensitive PNE materials for Hausa speaking patients with CSP were successfully produced. The present study also provides a direction for further research whereby the effects of culturally-sensitive PNE materials can be piloted among Hausa speaking patients with CSP.
... The sample size calculation was performed using G*Power and based on the effect sizes on our primary outcome measure pain knowledge measured with the NPQ. Since no study has ever reported on the pain knowledge of parents after a single PNE intervention delivered to their child, we looked at the effect size of one study assessing pain knowledge in children after a single PNE session delivered to the child [13], and two other studies assessing pain knowledge in adults with chronic fatigue syndrome (CFS) [32] and fibromyalgia [33] after a single PNE session delivered to the adult. These studies provided us with effect sizes between d = 1.7 and d = 2.8 for pain knowledge measured with the NPQ immediately measured after 1 session of PNE. ...
Article
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Pediatric chronic pain is a challenging problem for children and their families, although it is still under-recognized and under-treated. The aim of this study was to investigate whether a pain neuroscience education program for children (PNE4Kids) delivered to healthy children aged 8 to 12 years old and attended by their parents would result in improved parental knowledge about pain neurophysiology, decreased parental pain catastrophizing about their own pain and their children’s, decreased parental pain vigilance and awareness, and decreased fear of pain in children. Twenty-seven healthy child–parent dyads received a 45 min PNE4Kids session. Demographic data were collected, and the Neurophysiology of Pain Questionnaire (NPQ), Fear of Pain Questionnaire—Parent Proxy Report (FOPQ-P), Pain Catastrophizing Scale (PCS), Pain Catastrophizing Scale for Parents (PCS-P), and the Pain Vigilance and Awareness Questionnaire (PVAQ) were completed by the parents before and after the PNE4Kids session. Twenty-six dyads completed study participation. In response to the PNE4Kids session, significant short-term (1 week) improvements were shown in the NPQ (p < 0.001) and the FOPQ-P (p = 0.002). Parents’ level of pain knowledge and children’s fear of pain, reported by their parents, improved after a 45 min PNE4Kids session. Thus, PNE4Kids should likewise be further investigated in healthy child–parent dyads as it might be useful to target parental and children’s pain cognitions at a young age.
Book
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In general, the concept of a mechanism in biology has three distinct meanings. It may refer to a philosophical thesis about the nature of life and biology, to the internal workings of a machine-like structure, or to the causal explanation of a particular phenomenon [1]. Understanding the biological mechanisms that justify acute and chronic physiological responses to exercise interventions determines the development of training principles and training methods. A strong understanding of the effects of exercise in humans may help researchers to identify what causes specific biological changes and to properly identify the most adequate processes for implementing a training stimulus [1]. Despite the significant body of knowledge regarding the physiological and physical effects of different training methods (based on load dimensions), some biological causes of those changes are still unknown. Additionally, few studies have focused on natural biological variability in humans and how specific human properties may underlie different responses to the same training intervention. Thus, more original research is needed to provide plausible biological mechanisms that may explain the physiological and physical effects of exercise and training in humans. In this Special Issue, we discuss/demonstrate the biological mechanisms that underlie the beneficial effects of physical fitness and sports performance, as well as their importance and their role in/influences on physical health. A total of 28 manuscripts are published here, of which 25 are original articles, two are reviews, and one is a systematic review. Two papers are on neuromuscular training programs (NMTs), training monotony (TM), and training strain (TS) in soccer players [2,3]; five articles provide innovative findings about testosterone and cortisol [4,5], gastrointestinal hormones [6], spirulina [7], and concentrations of erythroferrone (ERFE) [8]; another five papers analyze fitness and its association with other variables [7,9–12]; three papers examine body composition in elite female soccer players [2], adolescents [6], and obese women [7]; five articles examines the effects of high-intensity interval training (HIIT) [7,10,13–15]; one paper examines the acute effects of different levels of hypoxia on maximal strength, muscular endurance, and cognitive function [16]; another article evaluates the efficiency of using vibrating exercise equipment (VEE) compared with using sham-VEE in women with CLBP (chronic lowback pain) [17]; one article compares the effects of different exercise modes on autonomic modulation in patients with T2D (type 2 diabetes mellitus) [14]; and another paper analyzes the changes in ABB (acid–base balance) in the capillaries of kickboxers [18]. Other studies evaluate: the effects of resistance training on oxidative stress and muscle damage in spinal cord-injured rats [19]; the effects of muscle training on core muscle performance in rhythmic gymnasts [20]; the physiological profiles of road cyclist in different age categories [21]; changes in body composition during the COVID-19 [22]; a mathematical model capable of predicting 2000 m rowing performance using a maximum-effort 100 m indoor rowing ergometer [23]; the effects of ibuprofen on performance and oxidative stress [24]; the associations of vitamin D levels with various motor performance tests [12]; the level of knowledge on FM (Fibromyalgia) [25]; and the ability of a specific BIVA (bioelectrical impedance vector analysis) to identify changes in fat mass after a 16-week lifestyle program in former athletes [26]. Finally, one review evaluates evidence from published systematic reviews and meta-analyses about the efficacy of exercise on depressive symptoms in cancer patients [27]; another review presents the current state of knowledge on satellite cell dependent skeletal muscle regeneration [28]; and a systematic review evaluates the effects of exercise on depressive symptoms among women during the postpartum period [29]
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Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
Article
The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18 to 55 years of age) was randomized into two groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a six-week, 12-session manual therapy and exercise program. The PSE enhancement involved two sessions of modern PSE, undertaken in the first two treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3 to 8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits. Perspective: The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019. https://clinicaltrials.gov/ct2/show/NCT03926767
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Objective Patients with persistent physical symptoms (PPS) require an explanation that is acceptable and comprehensible to them. Central sensitisation (CS) is an explanatory model for PPS and chronic pain that has been broadly applied in the context of pain medicine, but, until recently, not by general practitioners (GPs). We explored how GPs used the CS model in their consultations with patients with PPS. Design and setting A qualitative focus group study among GPs in the Netherlands. Methods We instructed 33 GPs on how to explain CS to patients with PPS. After 0.5–1.5 years of using the CS model, 26 GPs participated in focus groups and interviews to report and discuss their experiences with CS as an explanatory model. Audio recordings were transcribed and two researchers independently analysed the data. The text was coded, codes were organised into themes and discussed until consensus was reached. Results We identified eleven themes and grouped these into four categories. The GPs regarded the CS model as evidence-based, credible and giving recognition to the patient. On the other hand, they found explaining the CS model difficult and time-consuming. They tailored the CS model to their patients’ needs and used multiple consultations to explain the model. The GPs reported that the use of the CS model seemed to improve the understanding and acceptance of the symptoms by the patients and seemed to reduce their need for more diagnostic tests. Furthermore, patients seemed to become more motivated to accept appropriate therapy. Conclusion GPs reported that they were able to provide explanations with the CS model to their patients with PPS. They regarded the model as evidence-based, credible and giving recognition to the patient, but explaining it difficult and time-consuming.
Article
Objective Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions. Design In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers. Setting and methods We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve. Conclusions We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH. Trial Registration: ClinicalTrials.gov NCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5
Article
Rehabilitation refers to restoration or re-empowerment and aims to bring the patient “back to life”. In the case of chronic pain, the aim is not to cure the patient of pain, but to help ease their limitations and restore quality of life. In addition to mobility and restoration of the patient’s social relationships and participation, function is at the center of rehabilitation. It is therefore essential for the therapy that movement activity is the primary focus and that intrinsic and extrinsic barriers are identified and addressed in parallel. In particular, concepts that can act on maladaptive pain-processing mechanisms such as fear avoidance or endurance should be included in activating treatment concepts at an early stage.
Article
Purpose: To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia (FM) in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software for relevant outcomes and were pooled in a meta-analysis using the random effects model. Results: A total of 8 studies were included. The meta-analysis showed statistically significant differences in the pain intensity with a moderate clinical effect in 7 studies in the post-intervention assessment (SMD:-0.76; 95% CI:-1.33– -0.19; p<0.05) with evidence of significant heterogeneity (p<0.05, I2=92%) but not in fibromyalgia impact, anxiety, and pain catastrophizing (p>0.05). Regarding the follow-up assessment, only the fibromyalgia impact showed significant improvements with a very small clinical effect in 9 studies (SMD:-0.44; 95% CI:-0.73– -0.14; p<0.05) with evidence of significant heterogeneity (p<0.05, I2=80%). Applying a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease of pain intensity with a moderate clinical effect at post-intervention and follow-up without evidence of significant heterogeneity (p<0.05, I2=10%). Conclusions: There is low quality evidence that in patients with FM, PNE can decrease the pain intensity post-intervention and also the fibromyalgia impact in the follow-up. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.
Chapter
Lung cancer pain affects patients throughout the continuum of care and can present in numerous ways, often in conjunction with one another. In this chapter, we discuss a rehabilitation-focused approach to pain, specifically as it relates to lung cancer, the psychological impact of pain, and pain management strategies. Proper diagnosis of pain, along with an interdisciplinary treatment approach, provides patients with an individualized approach to care and improved outcomes.
Book
This book is a practical manual for clinical practitioners seeking to take an interdisciplinary and multidisciplinary approach to the diagnosis and management of functional movement disorder (FMD). It discusses case vignettes, reviews the diagnostic approach, provides an update on available treatments, highlights clinical pearls and details references for further reading. Organized into three parts, the book begins with a framework for conceptualizing FMD - including its historical context, the biopsychosocial model and an integrated neurologic-psychiatric perspective towards overcoming mind-body dualism. Part II then provides a comprehensive overview of different FMD presentations including tremor, dystonia, gait disorders, and limb weakness, as well as common non-motor issues such as pain and cognitive symptoms. The book concludes with chapters on updated practices in delivering the diagnosis, working with patients and care partners to achieve shared understanding of a complex condition, as well as an overview of evidence-based and evolving treatments. Supplemented with high-quality patient videos, Functional Movement Disorder is written for practicing neurologists, psychiatrists, psychologists, allied mental health professionals, and rehabilitation experts with an interest in learning more about diagnosis and management of FMD.
Chapter
There is growing evidence that physical therapy as part of multidisciplinary intervention is an effective treatment for people with functional movement disorder (FMD). In this chapter, we describe a psychologically informed and where possible, evidence-based, approach to physical therapy for FMD. The primary aim of physical therapy is to retrain normal movement patterns. The treatment approach should be individualised and based on a biopsychosocial understanding of the patient’s problems. Helping the patient to understand their diagnosis is the foundation to treatment and should incorporate information about how symptoms are generated and how physical therapy can help to restore movement. Movement retraining can follow the principles of motor learning, but should be applied in a way that redirects the patient’s focus of attention away from their body. A treatment package should incorporate development of self-management skills and consider coexisting problems such as pain and fatigue.KeywordsFunctional movement disorderFunctional neurological disorderDepressionAnxietyPsychiatry
Article
Background Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]). Objective To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients. Method A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants. Results No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < 0.05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < 0.001). Conclusion Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.
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To evaluate the fibromyalgia (FM) content in YouTube videos and verify if American College of Rheumatology (ACR) guidelines are being met. The videos were searched with the keyword “Fibromyalgia.” Two independent researchers evaluated and coded specific characteristics of the videos. The popularity of the videos, the presentation properties, and content related to FM according to the ACR criteria were analyzed. Of the 200 videos included, the majority were presented by health professionals, 61.5%. Most videos covered more than one subject, 38.5%. The videos presented by health professionals were the most viewed. Following the ACR guidelines, 38% defined FM, 24% described the etiology, 19.5% described the diagnostic criteria and 52% presented recommended management strategies. The results indicate that users mainly watch videos published by health professionals. Most of the published videos do not follow the information recommended by the ACR guidelines. Therefore, videos should be interpreted with caution, not being the most appropriate resource for health education for patients with FM. Most of the videos published on YouTube about FM do not meet the ACR guidelines for FM.
Article
Objectives: Assessing knowledge and beliefs regarding pain science can identify gaps and misconceptions. The Concept of Pain Inventory (COPI) was recently developed in children with the intent to guide targeted pain science education. We utilized the original COPI item pool to (1) develop a tool to assess an adult's concept of pain in a cohort who had not received pain science education, (2) evaluate its psychometric properties, (3) examine distribution of scores in a cohort of adults who had received pain science education, and (4) examine associations between scores and clinical variables. Methods: A total cohort of 627 adults were recruited via social media for an online survey. Initial development was conducted on those who had not received prior pain science education (n=125), then the COPI-Adult tool was tested in those who had received prior pain science education (n=502). Results: The resulting unidimensional 13-item COPI-Adult had acceptable internal consistency (α=0.78) and good test-retest reliability at 1 week (ICC(3,1)=0.84 (95%CI 0.71 to 0.91). Higher COPI-Adult scores reflect greater alignment with contemporary pain science. COPI-Adult scores were correlated with revised Neurophysiology of Pain Questionnaire (rNPQ) scores and inversely correlated with average and current pain intensity, and pain interference. Adults who reported having received pain science education had significantly higher mean COPI-Adult scores than those who had not, and this difference exceeded the smallest detectable change. Discussion: The COPI-Adult is a brief questionnaire with promising psychometric properties to identify conceptual gaps or misconceptions to inform individualized pain science education.
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Introduction: Worldwide, the number of people suffering from chronic pain is increasing; therefore, proper treatment is important. Current evidence underlines a positive effect caused by interprofessional rehabilitation approaches, which among others, include educational approaches. The aim of this study was to provide occupation-focused and educational interventions for clients with chronic musculoskeletal pain. Methods: To answer the question we performed a literature review. First, we searched systematically for literature in the databases. The content of the studies was evaluated and analysed based on previously defined criteria. Results: Eleven studies were included in the review. They are presented in detail. They investigated four educational approaches: 1. Education on the neurophysiological development of pain, 2. self-management and coping strategy training, 3. experience-based and occupation-focused education, and 4. back training. The results revealed positive effects on the clients’ understanding of pain and their everyday coping. Conclusion: Overall, the findings suggest that educational interventions for persons with chronic pain are effective, both, in improving the quality of occupational performance and pain intensity. Different evidence-based educational interventions exist, which are suitable for occupational therapy group settings. Schlüsselwörter Ergotherapie | muskuloskelettale chronische Schmerzen | betätigungsfokussiert | Edukation | Gruppenintervention Key Words occupational therapy | musculoskeletal chronic pain | occupation-focused | education | group intervention Bertschi, F.
Article
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Objectives Chronic widespread pain (CWP) is a common problem in primary health care, with a prevalence of 10–15%. An educational program called Pain School has been developed for use in primary health care, comprising four educational group sessions and 10 weeks of physical activity. The purpose of this study was to explore patients’ experiences with participating in an educational program that aims to increase their understanding of pain, self-efficacy, tools in daily life, and physical activity. Methods Twelve women (age 25–72 years) with CWP were included in this qualitative interview study set in primary health care. Semi-structured individual interviews were held 10 weeks after the completion of the four educational group sessions. Data was analyzed through the established method of content analysis, and the results are presented as a theme with categories and subcategories. Results An overarching theme that described the participants’ experiences with the educational program was e volvement of skills and perspectives to master pain . This theme covered four categories: understanding one’s body and mind, experiencing the value of participation, applying strategies and ways of thinking, and evaluating and adding to one’s personal framework. Participation contributed to an increased understanding of one’s body and mind and to experiencing the individual and social value of participation. The participants applied new strategies and ways of thinking related to pain and physical activity. An evaluation of the relevance for the individual and the value of being in the group could reinforce or add to the participants’ personal framework. Conclusions The educational program Pain School that was used in this study appears to give knowledge and support for women with CWP in primary health care and provide them with applicable skills and perspectives to manage pain.
Article
Fibromyalgia is a highly heterogeneous condition, but the most common symptoms are widespread pain, fatigue, poor sleep, and low mood. Non-pharmacological interventions are recommended as first-line treatment of fibromyalgia. However which interventions are effective for the different symptoms is not well understood. The objective of this study was to assess the efficacy of non-pharmacological interventions on symptoms and disease specific quality of life (QoL). Seven databases were searched from their inception until 1st June 2020. Randomised controlled trials (RCTs) comparing any non-pharmacological intervention to usual care, waiting list or placebo in people with fibromyalgia aged >16 years were included without language restriction. Fibromyalgia Impact Questionnaire (FIQ) was the primary outcome measure. Standardised mean difference (SMD) and 95% confidence interval (CI) were calculated using random effects model. The risk of bias (RoB) was evaluated using modified Cochrane tool. Of the 16,251 studies identified, 167 RCTs (n=11,012) assessing 22 non-pharmacological interventions were included. Exercise, psychological treatments, multi-disciplinary modality, balneotherapy and massage improved FIQ. Subgroup analysis of different exercise interventions found that all forms of exercise improved pain (ES -0.72 to -0.96) and depression (ES -0.35 to -1.22) except for flexibility-exercise. Mind-body and strengthening exercises improved fatigue (ES -0.77 to -1.00), whereas aerobic and strengthening exercises improved sleep (ES -0.74 to -1.33). Psychological treatments including cognitive behavioural therapy and mindfulness improved FIQ, pain, sleep, and depression (ES -0.35 to -0.55) but not fatigue. The findings of this study suggest that non-pharmacological interventions for fibromyalgia should be individualised according to the predominant symptom.
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Objective To prevent the deterioration of patients with fibromyalgia due to potentially avoidable harmful actions in clinical practice. Methods A multidisciplinary panel of experts identified key areas, analysed the scientific evidence and formulated recommendations based on this evidence and qualitative techniques of “formal assessment” or “reasoned judgement”. Results Thirty-nine recommendations were made on diagnosis, ineffective and unsafe treatments, patient education and practitioner training. This part II shows the 12 recommendations, referring to the latter two areas. Conclusions Good knowledge of fibromyalgia on the part of patients improves their coping and acceptance of the disease and reduces the severity of some clinical manifestations. Healthcare professionals treating patients with fibromyalgia should be well trained in this disease to improve treatment outcomes and patient relationships.
Chapter
Complex regional pain syndrome (CRPS) is a pain condition characterized by regional pain (often extremity pain) that is disproportionate in intensity to the original injury/illness. Cooccurring symptoms are autonomic and inflammatory in nature and may include swelling, temperature change, skin color changes, and motor changes, among others. Optimal treatment for CRPS utilizes a multidisciplinary approach, incorporating a team of specialty healthcare providers. Behavioral health interventions are a key domain of multidisciplinary care and have been shown to reduce functional impairments, pain, and comorbid psychological symptoms associated with CRPS. Behavioral health interventions are rooted in a biopsychosocial framework that accounts for biological, psychological, social, and environmental factors that influence pain and pain-related disability. The overarching aim of this chapter is to present an overview of evidence-based behavioral health treatments for chronic pain, as applied to CRPS, and consider promising directions for the field.
Article
Background: Fibromyalgia is a chronic condition characterized by generalized pain. Several studies have been conducted to assess the effects of non-pharmacological conservative therapies in fibromyalgia. Objective: To systematically review the effects of non-pharmacological conservative therapies in fibromyalgia patients. Methods: We searched MEDLINE, Cochrane library, Scopus and PEDro databases for randomized clinical trials related to non-pharmacological conservative therapies in adults with fibromyalgia. The PEDro scale was used for the methodological quality assessment. High-quality trials with a minimum score of 7 out of 10 were included. Outcome measures were pain intensity, pressure pain threshold, physical function, disability, sleep, fatigue and psychological distress. Results: Forty-six studies met the inclusion criteria. There was strong evidence about the next aspects. Combined exercise, aquatic exercise and other active therapies improved pain intensity, disability and physical function in the short term. Multimodal therapies reduced pain intensity in the short term, as well as disability in the short, medium and long term. Manual therapy, needling therapies and patient education provided benefits in the short term. Conclusions: Strong evidence showed positive effects of non-pharmacological conservative therapies in the short term in fibromyalgia patients. Multimodal conservative therapies also could provide benefits in the medium and long term.
Article
Purpose: Patients have responded in variable ways to pain science education about the psychosocial correlates of pain. To improve the effectiveness of pain education approaches, this study qualitatively explored participants’ perceptions of and responses to pain science education. Methods: We conducted a qualitative content analysis of interviews with fifteen, adult patients (73.3% female) who had recently attended a first visit to a chronic pain clinic and watched a pain science educational video. Results: Participants thought it was important to improve their and healthcare providers’ understanding of their pain. They viewed the video favorably, learned information from it, and thought it could feasibly facilitate communication with their healthcare providers, but, for many participants, the video either did not answer their questions and/or raised more questions. Participants’ responses to the video included negative and positive emotions and were influenced by their need for confirmation that their pain was real and personal relevance of the pain science content. Conclusion: Study results support the feasibility and value of delivering pain science education via video and increase our understanding of patients’ perceptions of and responses to pain science education. The video’s triggering of emotional responses warrants additional research.
Article
Background Pain education resources for children using appropriate language and illustrations remain scarce. Objectives We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. Methods A first draft of a comic book was developed (Portuguese and English) based on pain education concepts. Experts in pediatric pain from different countries analyzed content, objectives, language, illustrations, layout, motivation, and cultural adjustment. A third draft developed in Portuguese considering experts’ suggestions was presented to children and parents in Brazil. The total adequacy score was calculated from the sum of the scores obtained in each domain, divided by the maximum total score. Descriptive analysis is presented. Results The expert panel was composed of 11 (64.7%) physical therapists, and 6 (35.3%) psychologists. The total adequacy score (0-100%) was 87.74%. The third draft version of the comic book was presented to 28 children and the final version was presented to 16 children with a mean age of 9.6 years. Children were totally satisfied (n=4; 26.7%) or satisfied (n=9; 56.2%) with the story of the comic book. The readability of the comic book was considered suitable for grades 4 to 6 educational level. Conclusion The comic book “A Journey to Learn about Pain” was validated for face and content validity by the expert panel and the Brazilian target population. This comic book is available in Portuguese and English and can be a potentially useful resource for children.
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In Study 1, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers (n = 15) or noncatastrophizers (n = 15) on the basis of their PCS scores and participated in an cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity.
Article
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In Study I, the Pain Catastrophizing Scale (PCS) was administered to 425 undergraduates. Analyses yielded a three component solution comprising (a) rumination, (b) magnification, and (c) helplessness. In Study 2, 30 undergraduate participants were classified as catastrophizers ( n = 15) or noncatastrophizers ( n = 15) on the basis of their PCS scores and participated in a cold pressor procedure. Catastrophizers reported significantly more negative pain-related thoughts, greater emotional distress, and greater pain intensity than noncatastrophizers. Study 3 examined the relation between PCS scores, negative pain-related thoughts, and distress in 28 individuals undergoing an aversive electrodiagnostic medical procedure. Catastrophizers reported more negative pain-related thoughts, more emotional distress, and more pain than noncatastrophizers. Study 4 examined the relation between the PCS and measures of depression, trait anxiety, negative affectivity, and fear of pain. Analyses revealed moderate correlations among these measures, but only the PCS contributed significant unique variance to the prediction of pain intensity. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Objectives: This investigation aimed at determining the validity and reliability of the Dutch neurophysiology of pain test in chronic fatigue syndrome [CFS] patients with chronic widespread pain. Methods: The Dutch neurophysiology of pain test was completed by 61 CFS patients with chronic pain and 31 health care professionals. Patients repeated the test 24 hours later. Results: Performance on the test was better [p < 0.001] for professionals [10.71 +/- 3.08] than for patients [5.95 +/- 2.99], supporting the validity of the test. Test-retest reliability [ICC = 0.756] and internal consistency [Cronbach's alpha = 0.769] were fair for CFS patients. Conclusion: The Dutch neurophysiology of pain test appears valid and reliable in CFS patients with chronic pain.
Article
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The aim of randomization in clinical trials is the creation of groups that are comparable for any known or unknown, potentially confounding variables. Randomization, if done properly, ensures strengthening both the internal validity by minimizing selection bias and external validity by providing a correct basis for generalization. Randomization is a prime assumption to be fulfilled before the application of inferential statistics. Randomization in clinical trials generally refers to random allocation of subjects to treatment groups. Simple randomization, block randomization, stratified randomization, and minimization methods are discussed in this article.
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To evaluate the evidence for the effectiveness of neuroscience education (NE) for pain, disability, anxiety, and stress in chronic musculoskeletal (MSK) pain. Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect, and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All experimental studies including randomized controlled trials (RCTs), nonrandomized clinical trials, and case series evaluating the effect of NE on pain, disability, anxiety, and stress for chronic MSK pain were considered for inclusion. Additional limitations: studies published in English, published within the last 10 years, and patients older than 18 years. No limitations were set on specific outcome measures of pain, disability, anxiety, and stress. Data were extracted using the participants, interventions, comparison, and outcomes (PICO) approach. Methodological quality was assessed by 2 reviewers using the Critical Review Form-Quantitative Studies. This review includes 8 studies comprising 6 high-quality RCTs, 1 pseudo-RCT, and 1 comparative study involving 401 subjects. Most articles were of good quality, with no studies rated as poor or fair. Heterogeneity across the studies with respect to participants, interventions evaluated, and outcome measures used prevented meta-analyses. Narrative synthesis of results, based on effect size, established compelling evidence that NE may be effective in reducing pain ratings, increasing function, addressing catastrophization, and improving movement in chronic MSK pain. For chronic MSK pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain, disability, catastrophization, and physical performance.
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