Abstract
Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.
Highlights
Chronic musculoskeletal pain (CMP) affects more than one in five people [1,2,3], negatively affecting quality of life and generating suffering in people who suffer from it and in their companions [3,4]
In relation to effect size interpretation (Cohen’s d), we proposed the following: negligible
A total of 205 chronic spinal pain (CSP) patients were recruited at primary care (PC) consultations during the second half of January
Summary
Chronic musculoskeletal pain (CMP) affects more than one in five people [1,2,3], negatively affecting quality of life and generating suffering in people who suffer from it and in their companions [3,4]. CMP is mistakenly treated as long-lasting acute pain, employing for this purpose all available therapeutic options, which has led to an alarming increase in the prescription of opioids. This situation has generated enormous concern both for the poor medium- and long-term effects achieved with opioid administration and the increase in side effects. In the USA, overdose deaths have increased fourfold in recent years [19,20,21,22] This situation does not escape Spain (place of this clinical trial), where there has been an increase of more than 200% in the prescription of major opioids (fentanyl, tapentadol, and oxycodone), and in the regional Health Service where this trial was conducted, there are at moment more than 800 patients at risk for overdose [17]
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