Therapeutic Neuroscience Education for Patients with Chronic Low Back Pain and Its Effect on Activity Level, Pain Perception, and Function

Abstract

Background: Chronic low back pain (CLBP) is a significant cause of disability and inactivity in the United States. Patients with chronic pain are often symptomatic even in the absence of tissue damage. This is a major reason patients need to be educated about their pain. Cognitions such as fear, anxiety and faulty beliefs may impact the pain experiences and changing cognitions are important in changing pain behavior. If patients understand that the pain they are experiencing may not be a true indication of the health of their tissues, they may experience less fear of their pain, and may be able to return to previous activities. Purpose : To determine if a one-hour one-on-one therapeutic neuroscience education (TNE) session for patients with CLBP would have a positive effect on their pain, perceptions, function, and activity level. Subjects : Participants (2 males, 5 females mean age 38.3 years) who had been experiencing low back pain for >1 year and did not have a current exacerbation. Methods : All participants attended a one-hour one-on-one TNE session where they were educated about their pain using drawings, examples, and metaphors. Activity, depression, pain, fear avoidance behaviors, knowledge of pain mechanisms, and perceived disability were assessed before and after the session for all participants. Pain pressure algometry and diagnostic ultrasound were also used to measure muscle sensitivity and lateral abdominal wall thickness. Results: A Friedman’s ANOVA was used for data analysis. A statistically significant change in pain level was found on a Visual Analog Scale (VAS) for pain level today (p=.043), as well as the Fear Avoidance Belief Questionnaire-Physical Activity (FABQ-PA) subsection (p=.018). No other statistically significant changes were found. Discussion : Patients with CLBP often alter their activity levels due to pain and fear of increasing their pain. This alteration in activity level can have a negative impact on patients’ quality of life. With the intervention of a one-hour one-on-one TNE session participants had a significant decrease in pain levels and FABQ-PA scores. This decrease in both perceived pain and fear of their pain may increase physical activity, which could have a positive effect on patients’ overall quality of life. Conclusion : A one-hour one-on-one TNE session may be beneficial for patients with CLBP to decrease their pain level as well as decrease their fear of physical activity.