Effect of Duration of Pain Neuroscience Education on Pain Catastrophizing and Kinesiophobia in Patients with Chronic Low Back Pain: A Systematic Review of the Literature

Year 2024, Volume: 7 Issue: 4, 937 - 954

Ali İken Samia Karkouri İsmail Zeroual Houda El Moudane

https://doi.org/10.33438/ijdshs.1478011

Abstract

Objective: This study aims to examine the available evidence regarding the effect of the total duration in minutes of Pain Neuroscience Education (PNE) on pain catastrophizing and kinesiophobia in patients with chronic low back pain (CLBP). Methods: A systematic literature search was conducted on PubMed/MEDLINE, Web of Science, Scopus, and PeDro databases covering the last 5 years up to February 2024. No meta-analysis was performed, and qualitative analysis was conducted in narrative and tabular form. Results: Six randomized controlled trials were included in this systematic review. All studies included patients with chronic low back pain aged over 18. PNE was provided either as a standalone intervention or in combination with other therapies such as exercise, with total duration ranging from 100 to 240 minutes. Primary outcome measures focused on pain catastrophizing and kinesiophobia, while secondary outcomes included pain and functional disability. Conclusions: No significant correlation was established between the total duration of PNE and improvement in primary outcome measures. However, findings suggest that combining PNE with exercise in the treatment of chronic low back pain leads to greater improvements in kinesiophobia and pain catastrophizing compared to exercise alone.

Keywords

Pain Neuroscience Education, Kinesiophobia, Pain Catastrophizing, Chronic Low Back Pain, Systematic Review

Ethical Statement

The present systematic review was conducted in accordance with the ethical principles outlined in the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Statement. No specific ethical approval was required as this review was conducted using publicly available data and existing secondary analyses in the literature. All data were handled anonymously, and no information allowing the identification of participants was disclosed. No conflicts of interest were identified.

Supporting Institution

Not applicable

Project Number

PROSPERO Protocol (CRD42024500793)

Thanks

I wanted to express my sincere gratitude for the opportunity you have given me to submit my article to your journal. It is an honor for me to be able to contribute to your journal. Thank you again for your consideration. Best regards Ali IKEN

References

• Abenhaim, L., Rossignol, M., Valat, J., Nordin, M., Avouac, B., Blotman, F., Charlot, J., Dreiser, R. L., Legrand, E., Rozenberg, S., & Vautravers, P. (2000). The role of activity in the therapeutic management of back pain: Report of the international paris task force on back pain. Spine, 25(Supplement), 1S-33S. [PubMed]
• Aldington, D., & Eccleston, C. (2019). Evidence-based pain management: Building on the foundations of cochrane systematic reviews. American Journal of Public Health, 109(1), 46 49. [PubMed]
• Altman, D. G. (1990). Practical Statistics for Medical Research (1st ed.). Chapman and Hall.
• Arguisuelas, M. D., Lisón, J. F., Sánchez-Zuriaga, D., Martínez-Hurtado, I., & Doménech-Fernández, J. (2017). Effects of myofascial release in nonspecific chronic low back pain: A randomized clinical trial. Spine, 42(9), 627 634. [PubMed]
• Booth, A., Clarke, M., Dooley, G., Ghersi, D., Moher, D., Petticrew, M., & Stewart, L. (2012). The nuts and bolts of PROSPERO: An international prospective register of systematic reviews. Systematic Reviews, 1(1), 2. [PubMed]
• Cho, S., Kim, H.-Y., & Lee, J.-H. (2013). Validation of the Korean version of the Pain Catastrophizing Scale in patients with chronic non-cancer pain. Quality of Life Research, 22(7), 1767 1772. [PubMed]
• Chung, E. J., Hur, Y.-G., & Lee, B.-H. (2013). A study of the relationship among fear-avoidance beliefs, pain and disability index in patients with low back pain. Journal of Exercise Rehabilitation, 9(6), 532 535. [PubMed]
• Clarke, C. L., Ryan, C. G., & Martin, D. J. (2011). Pain neurophysiology education for the management of individuals with chronic low back pain: A systematic review and meta-analysis. Manual Therapy, 16(6), 544 549. [PubMed]
• De Morton, N. A. (2009). The PEDro scale is a valid measure of the methodological quality of clinical trials: A demographic study. Australian Journal of Physiotherapy, 55(2), 129 133. [PubMed]
• Fletcher, C., Bradnam, L., & Barr, C. (2016). The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study. Physiotherapy Theory and Practice, 32(4), 271 276. [PubMed]
• Gouvernement du Canada. (2019, June). Rapport du Groupe de travail canadien sur la douleur (GTCD). [CrossRef]
• Gül, H., Erel, S., & Füsun Toraman, N. (2021). Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial. Turkish Journal of Physical Medicine and Rehabilitation, 67(3), 283 290. [PubMed]
• Haute Autorité de Santé (HAS). (2019). Prise en charge du patient présentant une lombalgie commune. [CrossRef]
• Kong, J., Jensen, K., Loiotile, R., Cheetham, A., Wey, H.-Y., Tan, Y., Rosen, B., Smoller, J. W., Kaptchuk, T. J., & Gollub, R. L. (2013). Functional connectivity of the frontoparietal network predicts cognitive modulation of pain. Pain, 154(3), 459 467. [PubMed]
• Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041 2056. [PubMed]
• Louw, A., Puentedura, E. J., Zimney, K., & Schmidt, S. (2016). Know pain, know gain? A perspective on pain neuroscience education in physical therapy. Journal of Orthopaedic & Sports Physical Therapy, 46(3), 131 134. [PubMed]
• Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332 355. [PubMed]
• Maher, C. G., Sherrington, C., Herbert, R. D., Moseley, A. M., & Elkins, M. (2003). Reliability of the pedro scale for rating quality of randomized controlled trials. Physical Therapy, 83(8), 713 721. [PubMed]
• Maselli, F., Storari, L., Barbari, V., Colombi, A., Turolla, A., Gianola, S., Rossettini, G., & Testa, M. (2020). Prevalence and incidence of low back pain among runners: A systematic review. BMC Musculoskeletal Disorders, 21(1), 343. [PubMed]
• Meeus, M., Nijs, J., Van Oosterwijck, J., Van Alsenoy, V., & Truijen, S. (2010). Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: A double-blind randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 91(8), 1153 1159. [PubMed]
• Mills, K. M., Preston, E. B., Choffin Schmitt, B. M., Brochu, H. K., Schafer, E. A., Robinette, P. E., Sterling, E. K., & Coronado, R. A. (2021). Embedding pain neuroscience education in the physical therapy management of patients with chronic plantar fasciitis: A prospective case series. Journal of Manual & Manipulative Therapy, 29(3), 158 167. [PubMed]
• Mittinty, M. M., Vanlint, S., Stocks, N., Mittinty, M. N., & Moseley, G. L. (2018). Exploring effect of pain education on chronic pain patients’ expectation of recovery and pain intensity. Scandinavian Journal of Pain, 18(2), 211 219. [PubMed]
• Monticone, M., Ambrosini, E., Rocca, B., Foti, C., & Ferrante, S. (2016). Responsiveness of the Tampa Scale of Kinesiophobia in Italian subjects with chronic low back pain undergoing motor and cognitive rehabilitation. European Spine Journal, 25(9), 2882 2888. [PubMed]
• Moseley, G. L. (2003). Joining forces – combining cognition-targeted motor control training with group or individual pain physiology education: A successful treatment for chronic low back pain. Journal of Manual & Manipulative Therapy, 11(2), 88 94. [CrossRef]
• Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and future. The Journal of Pain, 16(9), 807 813. [PubMed]
• Nijs, J., Paul Van Wilgen, C., Van Oosterwijck, J., Van Ittersum, M., & Meeus, M. (2011). How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: Practice guidelines. Manual Therapy, 16(5), 413 418. [PubMed]
• Orhan, C., Lenoir, D., Favoreel, A., Van Looveren, E., Yildiz Kabak, V., Mukhtar, N. B., Cagnie, B., & Meeus, M. (2021). Culture-sensitive and standard pain neuroscience education improves pain, disability, and pain cognitions in first-generation Turkish migrants with chronic low back pain: A pilot randomized controlled trial. Physiotherapy Theory and Practice, 37(5), 633 645. [CrossRef]
• Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, n71. [PubMed]
• Rabiei, P., Sheikhi, B., & Letafatkar, A. (2021). Comparing pain neuroscience education followed by motor control exercises with group‐based exercises for chronic low back pain: A randomized controlled trial. Pain Practice, 21(3), 333 342. [PubMed]
• Romm, M. J., Ahn, S., Fiebert, I., & Cahalin, L. P. (2021). A meta‐analysis of therapeutic pain neuroscience education, using dosage and treatment format as moderator variables. Pain Practice, 21(3), 366 380. [PubMed]
• Salazar-Méndez, J., Núñez-Cortés, R., Suso-Martí, L., Ribeiro, I. L., Garrido-Castillo, M., Gacitúa, J., Mendez-Rebolledo, G., Cruz-Montecinos, C., López-Bueno, R., & Calatayud, J. (2023). Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis. Neuroscience & Biobehavioral Reviews, 153, 105328. [PubMed]
• Saracoglu, I., Arik, M. I., Afsar, E., & Gokpinar, H. H. (2022). The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial. Physiotherapy Theory and Practice, 38(7), 868 878. [PubMed]
• Siddall, B., Ram, A., Jones, M. D., Booth, J., Perriman, D., & Summers, S. J. (2022). Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis. Pain, 163(1), e20 e30. [PubMed]
• Song, J., Kim, H., Jung, J., & Lee, S. (2023). Soft-tissue mobilization and pain neuroscience education for chronic nonspecific low back pain with central sensitization: A prospective randomized single-blind controlled trial. Biomedicines, 11(5), 1249. [PubMed]
• Suzuki, H., Aono, S., Inoue, S., Imajo, Y., Nishida, N., Funaba, M., Harada, H., Mori, A., Matsumoto, M., Higuchi, F., Nakagawa, S., Tahara, S., Ikeda, S., Izumi, H., Taguchi, T., Ushida, T., & Sakai, T. (2020). Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain. PLOS ONE, 15(3), e0229228. [PubMed]
• Tegner, H., Frederiksen, P., Esbensen, B. A., & Juhl, C. (2018). Neurophysiological pain education for patients with chronic low back pain: A systematic review and meta-analysis. The Clinical Journal of Pain, 34(8), 778 786. [PubMed]
• Tu, Y., Zhang, B., Cao, J., Wilson, G., Zhang, Z., & Kong, J. (2019). Identifying inter-individual differences in pain threshold using brain connectome: A test-retest reproducible study. NeuroImage, 202, 116049. [PubMed]
• Watson, J. A., Ryan, C. G., Cooper, L., Ellington, D., Whittle, R., Lavender, M., Dixon, J., Atkinson, G., Cooper, K., & Martin, D. J. (2019). Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis. The Journal of Pain, 20(10), 1140.e1-1140.e22. [PubMed]
• Woby, S. R., Roach, N. K., Urmston, M., & Watson, P. J. (2005). Psychometric properties of the tsk-11: A shortened version of the tampa scale for kinesiophobia. Pain, 117(1), 137 144. [PubMed]
• Yamada, A. S. (2023). Physiotherapeutic treatment associated with neuroscience of pain education for patients with chronic non-specific low back pain-Single-blind randomized pilot clinical trial. Ağrı - The Journal of The Turkish Society of Algology. [PubMed]