Abstract
Self-efficacy beliefs are associated with less physical impairment and pain intensity in people with chronic pain. Interventions that build self-efficacy beliefs may foster behavioral changes among this population. A non-randomized trial has been carried out to evaluate the effectiveness of pain neuroscience education (PNE) plus usual care in modifying self-efficacy beliefs, pain intensity, pain interference and analgesics consumption in people with chronic musculoskeletal pain. Participants were allocated to an experimental (PNE plus usual care, n = 49) and a control (usual care alone, n = 51) group. The primary outcome was self-efficacy beliefs (Chronic Pain Self-Efficacy Scale), and the secondary outcomes were pain intensity, pain interference (Graded Chronic Pain Scale) and analgesics consumption. The participant’s pain knowledge (revised Neurophysiology of Pain Questionnaire) after PNE intervention was also assessed to analyze its influence on every outcome measure. All the outcome measures were assessed at the baseline and at four-week and four-month follow-ups. PNE plus usual care was more effective than usual care alone to increase self-efficacy beliefs and decrease pain intensity and pain interference at all follow-up points. No differences between groups were found in terms of analgesics consumption. Knowledge of pain neurophysiology did not modify the effects of PNE plus usual care in any of the outcome measures. These results should be taken with caution because of the non-randomized nature of this design, the limited follow-ups and the uncertainty of the presence of clinical changes in self-efficacy for participants. Larger, methodological sound trials are needed.
Highlights
A positive attitude is probably the first step needed to engage individuals with chronic musculoskeletal (MSK) pain in self-management strategies [1]
We investigated whether the knowledge acquired by participants in the intervention group (PNE plus usual care) about pain neurophysiology after treatment did/did not influence any of the outcome measures
The knowledge acquired by participants in the intervention group about pain neurophysiology did not modify the effects of pain neuroscience education (PNE) in any of the outcomes measured at the four-week (CPSS, p = 0.19; Graded Chronic Pain Scale (GCPS) pain, p = 0.55; GCPS pain interference, p = 0.89; analgesics consumption, p = 0.79) and four-month (CPSS, p = 0.72; GCPS pain, p = 0.87; GCPS pain interference, p = 0.99; analgesics consumption, p = 0.80) follow-ups
Summary
A positive attitude is probably the first step needed to engage individuals with chronic musculoskeletal (MSK) pain in self-management strategies [1]. Interventions that build self-efficacy beliefs may foster behavioral changes among individuals with chronic pain, such as greater physical activity participation and adherence to positive sleep habits. This may improve the quality of life in this population [12]. Pain neuroscience education (PNE) is an effective intervention to increase knowledge about pain neurophysiology among individuals with chronic pain [16], health professionals [17] and health students—e.g., physiotherapists—[18], and it is effective for reconceptualizing pain perceptions, which is vital in order to decrease uncertainties about the chronic pain process This intervention has been found to produce low clinical relevance effects in decreasing pain and disability, but medium clinical relevance effects in reducing psychological factors such as kinesiophobia and pain catastrophizing in people with chronic MSK pain [19]
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