Carryover Effects of Pain Neuroscience Education on Patients with Chronic Lower Back Pain: A Systematic Review and Meta-Analysis.

Abstract

Background and Objectives: Because most individuals with chronic back pain (CLBP) have no specific cause, it is usually described as central sensitization. Pain neuroscience education (PNE) in top-down pain control may be effective against carryover effects; however, this remains unclear. In this study, the carryover effect was qualitatively and quantitatively synthesized and analyzed. Materials and Methods: Randomized controlled trials (RCTs) on PNE in individuals with CLBP were conducted using international databases until January 2023. Using RevMan5.4 provided by Cochrane, qualitative and quantitative analyses were performed with a risk of bias and meta-analysis, respectively. Results: Nine RCTs involving 1038 individuals with CLBP were included in the analysis. Four main results were identified: First, PNE had a short-term carryover effect on pain intensity (SMD = -1.55, 95% confidence interval [CI] = -2.59 to -0.50); second, PNE had a short-term carryover effect on pain catastrophizing (SMD = -2.47, 95% CI = -3.44 to -1.50); third, PNE had short- and long-term carryover effects on kinesiophobia (SMD = -3.51, 95% CI = -4.83 to -2.19); fourth, the appropriate therapeutic intensity of PNE for the pain intensity of individuals (SMD = -0.83, 95% CI = -1.60 to -0.07). Conclusions: PNE has a short-term carryover effect on pain intensity and pain cognition in individuals with CLBP and a long-term carryover effect on kinesiophobia.