Physical Therapy Rehabilitation Science

korean Academy of Physical Therapy Rehabilitation Science (물리치료재활과학회)
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Effects of pain neuroscience education on kinesiophobia in patients with chronic pain: a systematic review and meta-analysis

  • Kim, Hyunjoong (Sports Rehabilitation Center, The Better Hospital) ;
  • Lee, Seungwon (Department of Physical Therapy, College of Health Science and Social Welfare, Sahmyook University)
  • Received : 2020.11.30
  • Accepted : 2020.12.08
  • Published : 2020.12.31
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Abstract

Objective: One of the treatment strategies for controlling chronic pain and preventing disability is patient education. Pain neuroscience education (PNE) has been proven to be effective in explaining the biological and physiological processes associated with pain experiences to patients. The purpose of this review is to investigate the effectiveness of PNE for kinesiophobia such as avoidance response in patients with chronic pain. Design: A systematic review and meta-analysis. Methods: MEDLINE, EMBASE, CINAHL, PEDro, and the Cochrane Central Register of controlled trials databases were searched through November 2020 and included a randomized controlled trials evaluating kinesiophobia in musculoskeletal patients with chronic pain. In 8 randomized controlled trial studies, 'Cochrane's risk of bias (RoB) tool was used for qualitative analysis, and results of post-intervention were analyzed through RevMan 5.4 for quantitative analysis. Results: For this review, 8 randomized controlled trials of 369 patients with chronic pain were selected for PNE. A systematic review and meta-analysis also included 8 randomized controlled trials. The effect on kinesiophobia was more effective than the control group (-0.86; 95% confidence interval [CI], -1.22 to -0.51; heterogeneity [χ2=21.18, df=7, I2=67%]; overall effect [Z=4.80]). In addition, the effect on pain was more effective than the control group (-0.53; 95% CI, -1.05 to -0.01; heterogeneity [χ2=47.42, df=7, I2=85%]; overall effect [Z=2.01]). Conclusions: The results of this review suggest that PNE and combined PNE have a positive effect on the improvement of pain and kinesiophobia in patients with chronic pain.

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References

  1. Ploumis A, Gkiatas I. Musculoskeletal pain management. In: Paschos N, Bentley G, editors. General orthopaedics and basic science. Cham: Springer; 2019. p. 105-10.
  2. Main CJ, Spanswick CC. Pain management: an interdisciplinary approach. Edinburgh: Churchill Livingstone; 2000.
  3. Ekman EF, Koman LA. Acute pain following musculoskeletal injuries and orthopaedic surgery: mechanisms and management. Instr Course Lect 2005;54:21-33.
  4. Baliki MN, Geha PY, Apkarian AV, Chialvo DR. Beyond feeling: chronic pain hurts the brain, disrupting the default-mode net-work dynamics. J Neurosci 2008;28:1398-403.
  5. Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356-66.
  6. Lundberg M, Larsson M, Ostlund H, Styf J. Kinesiophobia among patients with musculoskeletal pain in primary healthcare. J Rehabil Med 2006;38:37-43.
  7. Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR. Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J 2008;8:948-58.
  8. Engers A, Jellema P, Wensing M, van der Windt DA, Grol R, van Tulder MW. Individual patient education for low back pain. Cochrane Database Syst Rev 2008;2008:CD004057.
  9. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for nonspecific low back pain: a systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2005;30:2153-63.
  10. Liddle SD, Baxter GD, Gracey JH. Chronic low back pain: patients' experiences, opinions and expectations for clinical management. Disabil Rehabil 2007;29:1899-909.
  11. Maier-Riehle B, Harter M. The effects of back schools--a metaanalysis. Int J Rehabil Res 2001;24:199-206.
  12. Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther 2003;8:130-40.
  13. Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 2004;8:39-45.
  14. Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: a review of randomized clinical trials. J Clin Epidemiol 1994;47:851-62.
  15. Waddell G. The back pain revolution. 2nd ed. Edinburgh: Churchill Livingstone; 2004.
  16. Nijs J, Roussel N, Paul van Wilgen C, Koke A, Smeets R. Thinking beyond muscles and joints: therapists' and patients' attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment. Man Ther 2013;18:96-102.
  17. Nijs J, Paul 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;16:413-8.
  18. Louw A, Puentedura EJ, Diener I, Peoples RR. Preoperative therapeutic neuroscience education for lumbar radiculopathy: a single-case fMRI report. Physiother Theory Pract 2015;31:496-508.
  19. Zimney K, Louw A, Puentedura EJ. Use of Therapeutic Neuroscience Education to address psychosocial factors associated with acute low back pain: a case report. Physiother Theory Pract 2014;30:202-9.
  20. Butler DS, Moseley GL. Explain pain. Adelaide: Noigroup Publications; 2003.
  21. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. J Pain 2015;16:807-13.
  22. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil 2011;92:2041-56.
  23. Moseley GL. Reconceptualising pain according to modern pain science. Phys Ther Rev 2007;12:169-78.
  24. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 2004;20:324-30.
  25. Nijs J, Lluch Girbes E, Lundberg M, Malfliet A, Sterling M. Exercise therapy for chronic musculoskeletal pain: innovation by altering pain memories. Man Ther 2015;20:216-20.
  26. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions. 2nd ed. Hoboken (NJ): Wiley-Blackwell; 2019.
  27. Oh PJ, Kim YL. Effectiveness of non-pharmacologic interventions in chemotherapy induced peripheral neuropathy: a systematic review and meta-analysis. J Korean Acad Nurs 2018;48:123-42.
  28. Saracoglu I, Arik MI, Afsar E, Gokpinar HH. The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial. Physiother Theory Pract 2020. doi: 10.1080/09593985.2020.1809046. [Epub ahead of print]
  29. Malfliet A, Kregel J, Meeus M, Roussel N, Danneels L, Cagnie B, et al. Blended-learning pain neuroscience education for people with chronic spinal pain: randomized controlled multicenter trial. Phys Ther 2018;98:357-68.
  30. Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther 2010;15:382-7.
  31. Heathcote LC, Pate JW, Park AL, Leake HB, Moseley GL, Kronman CA, et al. Pain neuroscience education on YouTube. PeerJ 2019;7:e6603.
  32. Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial. Clin J Pain 2013;29:873-82.
  33. Bodes Pardo G, Lluch Girbes E, Roussel NA, Gallego Izquierdo T, Jimenez Penick V, Pecos Martin D. Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: a single-blind randomized controlled trial. Arch Phys Med Rehabil 2018;99:338-47.
  34. Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, et al. Effect of pain neuroscience education combined with cognition-targeted motor control training on chronic spinal pain: a randomized clinical trial. JAMA Neurol 2018;75:808-17.
  35. Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. 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. Arch Phys Med Rehabil 2010;91:1153-9.
  36. Valiente-Castrillo P, Martin-Pintado-Zugasti A, Calvo-Lobo C, Beltran-Alacreu H, Fernandez-Carnero J. Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: a randomized clinical trial. Acupunct Med 2020. doi: 10.1177/0964528420920300. [Epub ahead of print]