Effectiveness of In-group Individually Administered Pain Neuroscience Education on Clinical and Psychosocial Outcomes in Patients with Chronic Low Back Pain: Randomized Controlled Study Protocol

Overview

Journal PeerJ

Specialties Biology
Environmental Health
General Medicine

Date 2024 Jun 4

PMID 38832030

Authors

Joaquin Salazar-Mendez

Ivan Cuyul-Vasquez

Felipe Ponce-Fuentes

Rodrigo Nunez-Cortes

Guillermo Mendez-Rebolledo

Jorge Fuentes

Affiliations

Soon will be listed here.

Abstract

Objective: (1) This trial will compare the clinical and psychosocial effectiveness of in-group and individually pain neuroscience education (PNE) in patients with chronic low back pain (CLBP). In addition, (2) the influence of social determinants of health on post-treatment results will be analyzed.

Methods: A three-arm randomized controlled trial will be conducted. Sixty-nine participants with CLBP will be recruited in a 1:1:1 ratio. Participants, assessor, and statistician will be blinded to group assignment. The PNE intervention will be adapted to the context of the participants. An experimental group ( = 33) will receive PNE in an in-group modality, the other experimental group ( = 33) will receive PNE in an individually modality and the control group ( = 33) will continue with usual care. Additionally, participants will be encouraged to stay active by walking for 20-30 min 3-5 times per week and will be taught an exercise to improve transversus abdominis activation (bracing or abdominal following). The outcome measures will be fear avoidance and beliefs, pressure pain threshold, pain self-efficacy, catastrophizing, pain intensity, and treatment expectation. Outcome measures will be collected at one-week before intervention, immediately post-intervention, and four-weeks post-intervention.

Conclusion: The innovative approach of PNE oriented to fear beliefs proposed in this study could broaden the application strategies of this educational therapeutic modality. Impact. Contextualized PNE delivered by physical therapist could be essential to achieve a good cost-effectiveness ratio of this intervention to improve the clinical condition of people with CLBP.

Citing Articles

Models of care for managing non-specific low back pain.

Docking S, Sridhar S, Haas R, Mao K, Ramsay H, Buchbinder R Cochrane Database Syst Rev. 2025; 3:CD015083.

PMID: 40052535 PMC: 11887030. DOI: 10.1002/14651858.CD015083.pub2.

References

Salazar-Mendez J, Cuyul-Vasquez I, Ponce-Fuentes F, Guzman-Munoz E, Nunez-Cortes R, Huysmans E . Pain neuroscience education for patients with chronic pain: A scoping review from teaching-learning strategies, educational level, and cultural perspective. Patient Educ Couns. 2024; 123:108201. DOI: 10.1016/j.pec.2024.108201. View

Moseley L . Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002; 48(4):297-302. DOI: 10.1016/s0004-9514(14)60169-0. View

Dube M, Langevin P, Roy J . Measurement properties of the Pain Self-Efficacy Questionnaire in populations with musculoskeletal disorders: a systematic review. Pain Rep. 2021; 6(4):e972. PMC: 8701870. DOI: 10.1097/PR9.0000000000000972. View

Marshall A, Joyce C, Tseng B, Gerlovin H, Yeh G, Sherman K . Changes in Pain Self-Efficacy, Coping Skills, and Fear-Avoidance Beliefs in a Randomized Controlled Trial of Yoga, Physical Therapy, and Education for Chronic Low Back Pain. Pain Med. 2021; 23(4):834-843. PMC: 8992579. DOI: 10.1093/pm/pnab318. View

Lee H, Hubscher M, Moseley G, Kamper S, Traeger A, Mansell G . How does pain lead to disability? A systematic review and meta-analysis of mediation studies in people with back and neck pain. Pain. 2015; 156(6):988-997. DOI: 10.1097/j.pain.0000000000000146. View

Cote P, Baldwin M, Johnson W, Frank J, Butler R . Patterns of sick-leave and health outcomes in injured workers with back pain. Eur Spine J. 2008; 17(4):484-93. PMC: 2295281. DOI: 10.1007/s00586-007-0577-6. View

Vlaeyen J, Linton S . Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000; 85(3):317-332. DOI: 10.1016/S0304-3959(99)00242-0. View

Rabiei P, Sheikhi B, Letafatkar A . Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group-Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial. Pain Pract. 2020; 21(3):333-342. DOI: 10.1111/papr.12963. View

Wertli M, Rasmussen-Barr E, Weiser S, Bachmann L, Brunner F . The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review. Spine J. 2014; 14(5):816-36.e4. DOI: 10.1016/j.spinee.2013.09.036. View

10.

Louw A, Diener I, Butler D, Puentedura E . The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil. 2011; 92(12):2041-56. DOI: 10.1016/j.apmr.2011.07.198. View

11.

Pincus T, Burton A, Vogel S, Field A . A systematic review of psychological factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine (Phila Pa 1976). 2002; 27(5):E109-20. DOI: 10.1097/00007632-200203010-00017. View

12.

Koenig A, Kupper A, Skidmore J, Murphy K . Biopsychosocial functioning and pain self-efficacy in chronic low back pain patients. J Rehabil Res Dev. 2015; 51(8):1277-86. DOI: 10.1682/JRRD.2014.02.0047. View

13.

Nunez-Cortes R, Salazar-Mendez J, Calatayud J, Malfliet A, Lluch E, Mendez-Rebolledo G . The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose-response meta-analysis. Pain. 2023; 165(6):1196-1206. DOI: 10.1097/j.pain.0000000000003126. View

14.

Pincus T, Vlaeyen J, Kendall N, Von Korff M, Kalauokalani D, Reis S . Cognitive-behavioral therapy and psychosocial factors in low back pain: directions for the future. Spine (Phila Pa 1976). 2002; 27(5):E133-8. DOI: 10.1097/00007632-200203010-00020. View

15.

Leeuw M, Goossens M, Linton S, Crombez G, Boersma K, Vlaeyen J . The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2006; 30(1):77-94. DOI: 10.1007/s10865-006-9085-0. View

16.

Louw A, Puentedura E, Zimney K . Teaching patients about pain: It works, but what should we call it?. Physiother Theory Pract. 2016; 32(5):328-31. DOI: 10.1080/09593985.2016.1194669. View

17.

Moseley G, Butler D . Fifteen Years of Explaining Pain: The Past, Present, and Future. J Pain. 2015; 16(9):807-13. DOI: 10.1016/j.jpain.2015.05.005. View

18.

Riemsma R, Taal E, Rasker J . Group education for patients with rheumatoid arthritis and their partners. Arthritis Rheum. 2003; 49(4):556-66. DOI: 10.1002/art.11207. View

19.

Nijs J, van Wilgen C, Van Oosterwijck J, van Ittersum M, Meeus M . How to explain central sensitization to patients with 'unexplained' chronic musculoskeletal pain: practice guidelines. Man Ther. 2011; 16(5):413-8. DOI: 10.1016/j.math.2011.04.005. View

20.

Zale E, Ditre J . Pain-Related Fear, Disability, and the Fear-Avoidance Model of Chronic Pain. Curr Opin Psychol. 2015; 5:24-30. PMC: 4383173. DOI: 10.1016/j.copsyc.2015.03.014. View