Neurophysiology Of Pain Research Articles

Reliability of the Revised Neurophysiology of Pain Questionnaire-Turkish in patients with neck pain: a cross-validation study

Background & Objectives: The Neurophysiology of Pain Questionnaire (NPQ) measures the level of knowledge of patients and healthcare professionals regarding the neurophysiology of pain. The revised Turkish (Tr) version has low reliability for patients with chronic spinal pain. In this study, we investigated the reliability of the Revised NPQ-Tr in patients with neck pain. Methodology: The Revised NPQ-Tr was administered to 219 participants suffering from neck pain for at least 3 months, who were between the ages of 25 and 60 y and native Turkish speakers. Correct responses were awarded one point, while undecided or incorrectly marked responses were awarded 0 points. In order to analyse the validity of the test, the high-scoring and low-scoring groups were compared. Using the percentage of correct responses in the high and low scoring groups, we calculated the difficulty of the item (P-value) and the discrimination power of the item (r). Results: Responses to the questionnaire were highly correlated. Items 1 and 2 had high discrimination power (r > 0.40), and items 3 and 5 had very good item quality (0.30 < r < 0.39). Among the items ranked between 1-7 and 9-12 in terms of difficulty of the item and discrimination power, only item 8 was found to be a difficult yet discriminating item (P < 0.60). According to Cronbach's alpha (0.81) and Kuder-Richardson-20 (0.81) coefficients, the questionnaire had a high internal consistency and reliability, and a split-half correlation coefficient (0.802) determined its internal consistency and reliability. Conclusion: We conclude that the Neurophysiology of Pain Questionnaire-Turkish can be used on neck pain, and it is reliable and highly valid. Keywords: Chronic Pain, neck pain, pain knowledge, pain education, pain beliefs, Turkish language, reliability, validity. Citation: Yasarer O, Sari Z, Copuroglu OB, Eker TA, Aydogdu O. Reliability of the Revised Neurophysiology of Pain Questionnaire-Turkish in patients with neck pain: a cross-validation study. Anaesth. pain intensive care 2024;28(5):859−865; DOI: 10.35975/apic.v28i5.2552 Received: August 04, 2024; Reviewed: August 14, 2024; Accepted: August 17, 2024

Pain Neuroscience Education and Neuroimaging-A Narrative Review.

Musculoskeletal pain is a leading cause of medical visits, posing significant challenges both socially and economically, encouraging the scientific community to continue researching and exploring the most effective methods to address the problem. An alternative way to deal with chronic pain is pain neuroscience education (PNE), a lesson plan that addresses the neurobiology, neurophysiology, and nervous system processing of pain. This method takes the place of the conventional one, which connected pain to tissue damage or nociception. As a result, patients are taught that pain is often not a reliable measure of the health of the tissues but rather the outcome of the nervous system interpreting the injury in conjunction with additional psychosocial variables. In addition to finding research that examine, using neuroimaging, whether the administration of PNE has detectable effects at the level of the central nervous system, this narrative review seeks to clarify what PNE is, how it is administered, and if it is an effective treatment for musculoskeletal pain. Based on the findings, it appears that PNE is more therapeutically beneficial when combined with therapeutic exercise, when done one-on-one, and during lengthy, frequent sessions. Lastly, even though PNE has no effect on the morphological properties of the gray matter, it appears to cause decreased activation of the regions linked to pain.

Designing and Implementing a Telehealth Simulation for Pain Neuroscience Education in a Doctor of Physical Therapy Curriculum: A Pilot Study

There is continuing debate over the best pedagogical approach to deliver modern pain science knowledge. Experiential learning, such as simulation, may better promote application and retention of curricular material. This study investigated changes in knowledge of pain neurophysiology, attitudes, beliefs and clinical recommendations towards chronic low back pain (CLBP) after participation in a telehealth simulation for pain neuroscience education (PNE). A convenience sample of twenty-one Doctor of Physical Therapy (DPT) students, age 23.6 (± 3.60), completed the simulation. Students completed a pre- and post-questionnaire consisting of the Revised Neurophysiology of Pain Questionnaire (rNPQ) Healthcare Providers’ Pain and Impairments Relationship Scale (HC-PAIRS) and clinical vignette. Additionally, the post simulation survey included the Simulation Effectiveness Tool Modified (SET-M). Descriptive statistics were utilized to analyze all data. Pre- and post-rNPQ mean (SD) scores improved from 5.38 ±1.24 (44.8%) to 6.48 ±1.36 (54%). HC-PAIRS mean (SD) scores lowered from 51.76 ± 9.64 to 47.14 ±5.41, indicating a positive shift in attitudes and beliefs relating to CLBP. All appropriate clinical recommendations improved after post simulation. The mean (SD) SET-M score was 54.9 ±3.66. Experiential learning via a PNE telehealth simulation improved knowledge of pain neurophysiology, positively shifted attitudes and beliefs towards CLBP, while also improving appropriate clinical recommendations. The SET-M scores present the learners perspective and provide guidance in adapting the simulation in the future. Further research should include a longitudinal design with a long-term follow up, a larger sample size across different curricula and a qualitative component to explore the student experience.

Italian versions of the Neurophysiology of Pain Questionnaire (NPQ): psychometric properties and an investigation on the understanding of pain neurophysiology in physical therapists

ObjectivesThe Neurophysiology of Pain Questionnaire (NPQ) is widely used to assess pain knowledge among clinicians and patients with pain, but an Italian version is not available. This study aimed to translate and cross-culturally adapt the NPQ into Italian, to test its psychometric properties, to assess the knowledge of Italian physical therapists (PTs) on pain, and to evaluate which characteristics are associated with pain knowledge. MethodsThe NPQ was translated into Italian, integrated with some additional questions (IT-NPQ-New), and sent by email via the Italian Association of Physiotherapy newsletter. Rasch analysis (RA) was used to test the psychometric properties of the Italian versions. Multivariable regression analyses were used to check for associations between participants' characteristics and their NPQ scores. ResultsA sample of 753 PTs completed the survey. RA of the NPQ-19 and IT-NPQ-New revealed that 10 (IT-NPQ-10) and 18 (IT-NPQ-18) items fit the model. Both questionnaires showed good psychometric properties. The overall median score among Italian PTs was 6.0 [5.0–7.0] and 11.0 [9.0–13.0] points for the IT-NPQ-10 and the IT-NPQ-18, respectively. These scores were statistically different among groups according to gender, age, years of professional activity, post-graduate specialization and days attended of targeted pain courses, with the latter being the most influential variable. ConclusionsItalian PTs now dispose of two tools to assess their basic knowledge related to pain science. Our study also showed that pain knowledge among Italian PTs needs improvement, especially considering recent biopsychosocial approaches to pain.

Assessing healthcare professionals' perceptions of pain concepts and beliefs.

Healthcare professionals deliver pain education, yet their perception of pain experiences is not well understood, which can affect their interactions with patients in pain. This study explored Korean healthcare professionals' perceptions of the usefulness of assessing pain concepts and beliefs and the importance of domains identified in the pain literature. This descriptive cross-sectional study employed an online survey administered to nurses, physical therapists, and physicians, including the Neurophysiology of Pain Questionnaire, Tampa Scale for Kinesiophobia, and related optional open-ended questions. Most participants acknowledged the importance and usefulness of assessing understanding of pain concepts but anticipated patients' difficulty comprehending items assessing biological mechanisms underlying pain. Participants questioned the items' accuracy, indicating their limited pain knowledge and the necessity of reducing literacy demands. The critical domains of pain education were learning about pain, external factors influencing pain, and pain as a form of protection. Participants had suboptimal pain knowledge but emphasized decreasing literacy demands of pain neurophysiology items. Additionally, it is necessary to develop and implement a pain education program to improve pain-related knowledge and provide educational content for healthcare professionals encountering patients in pain.

Neurophysiology of corneal neuropathic pain and emerging pharmacotherapeutics.

The altered activity generated by corneal neuronal injury can result in morphological and physiological changes in the architecture of synaptic connections in the nervous system. These changes can alter the sensitivity of neurons (both second-order and higher-order projection) projecting pain signals. A complex process involving different cell types, molecules, nerves, dendritic cells, neurokines, neuropeptides, and axon guidance molecules causes a high level of sensory rearrangement, which is germane to all the phases in the pathomechanism of corneal neuropathic pain. Immune cells migrating to the region of nerve injury assist in pain generation by secreting neurokines that ensure nerve depolarization. Furthermore, excitability in the central pain pathway is perpetuated by local activation of microglia in the trigeminal ganglion and alterations of the descending inhibitory modulation for corneal pain arriving from central nervous system. Corneal neuropathic pain may be facilitated by dysfunctional structures in the central somatosensory nervous system due to a lesion, altered synaptogenesis, or genetic abnormality. Understanding these important pathways will provide novel therapeutic insight.

Development and validation of aquestionnaire to assess physiotherapists' postural-structural-biomechanical-oriented beliefs about pain

Therapists frequently use the postural-structural-biomechanical (PSB) model in clinical practice to explain the symptom of pain using biomechanical deficits. Adequate knowledge about pain encompasses not only the neurophysiology of pain but also knowledge that existing PSB-oriented explanations of the development and enhancement of pain are outdated. There is no assessment to evaluate physiotherapists' PSB-oriented beliefs about pain. The aim of the present study was to develop aquestionnaire to assess physiotherapists' PSB-oriented beliefs about pain and to evaluate its reliability (internal consistency), validity, and agreement. The Essential Knowledge of Pain Questionnaire (EKPQ) was constructed on the basis of aliterature search and discussions between experts. In apilot study, 32pupils of aphysiotherapy school were then asked to complete the German version of the revised Neurophysiology of Pain Questionnaire (rNPQ-D) and the EKPQ using the SoSci Survey in order to assess their knowledge and beliefs about pain. The internal consistency of the EKPQ was acceptable with aCronbach's α = 0.784. There was astrong positive significant correlation between the questionnaires (r = 0.518; p = 0.002). The Bland-Altman analysis revealed amean difference of 28.9% (± standard deviation of the difference 15.3%) with an upper limit of 95% agreement of 58.8% and alower limit of 95% agreement of -1.0% between the questionnaires. Participants achieved amean score of 60.7% in the rNPQ‑D and amean score of 31.8% in the EKPQ. The newly developed EKPQ questionnaire seems to be areliable and valid assessment to determine physiotherapists' PSB-oriented beliefs about pain. The results also confirm that ahigh level of knowledge about the neurophysiology of pain does not exclude aPSB orientation. Whether the EKPQ can be used alongside the rNPQ as an additional assessment to evaluate beliefs about pain should be investigated in the future with suitable study designs, e.g. Delphi study.

Association of pain neurophysiology knowledge and application amongst UK chiropractic students: A cross-sectional study.

To investigate if chiropractic placement students in the United Kingdom are aware of current pain evidence and how they relate this to the management of chronic pain patients. Moreover, to gain an understanding of how this can lead to improved pain education planning and engagement in the future. The revised Neurophysiology of Pain Questionnaire and the researchers' own questionnaire were administered online to chiropractic placement students. The aggregated total number of correct responses and the individual mean scores were calculated. Statistical analysis included tests of normality and difference using the Kolmogorov-Smirnov, Mann-Whitney U, Kruskal-Wallis, and Χ2 tests. There was an overall response rate of 21.6% (n = 50). The mean score achieved on the revised neurophysiology of pain questionnaire was 37.8%. A significant difference between individual mean scores on the revised Neurophysiology of Pain Questionnaire was observed between male and female participants. No differences in mean score were observed between age, number of chronic pain patients seen, and previous qualifications. For the study-specific questionnaire, statistically significant differences were found in mean score for previous qualifications, number of patients seen, and sex. Chiropractic placement students in the United Kingdom appear to have a lower level of pain knowledge than other health care professionals and education institutions may wish to consider how to best address this within their curricula.

The effect of patient-led goal setting approach combined with pain neuroscience education or manual therapy in patients with chronic low back pain: protocol for a parallel-group randomized controlled trial

BackgroundLow back pain (LBP) is a multifactorial disorder associated with a high range of physical and psychological burden on the society. Patient-led goal-setting approach has shown potential effects for improving chronic LBP. However, there are few studies investigating its benefits when combined with a supplementary intervention. This paper, therefore, presents a protocol for a randomized control trial (RCT) to study the effect of a patient-led goal-setting approach combined with pain neuroscience education (PNE) or manual therapy (MT) among patients with chronic LBP.MethodsA total of 105 patients suffering from chronic LBP will be recruited via flyers displayed in hospitals and universities, and those meeting the study’s criteria will randomly be allocated into a patient-led goal-setting approach with the PNE group, and/or with the MT program group, and/or a control group. The primary outcomes will be the pain intensity and disability. Secondary outcomes include quality of life, depression, anxiety and stress, fear avoidance beliefs, kinesophobia, pain self-efficacy, catastrophic pain, neurophysiology of pain, and central sensitivity. All the outcomes will be recorded at 2 months after receiving the treatment as post-test sessions and after 4 and 12 months as follow-up sessions. The Ethics Committee in Research at Sport Sciences Research Institute of Iran approved the protocol of this trial (IR.SSRC.REC.1400.084). Written, informed consent to participate will be obtained from all participants. All methods will be conducted in accordance with the ethical standards of the Declaration of Helsinki and in accordance with relevant guidelines and regulations. We will disseminate the findings through peer-reviewed publications and conference presentations and send them to the participants.DiscussionThis trial will demonstrate which supplementary intervention can better improve the impact of a patient-led goal-setting approach to treat LBP. If successful, the results will potentially have implications for athletic trainers, physiotherapists, and health care practitioners.Trial registrationIRCT Iranian Registry of Clinical Trials IRCT20210927052616N1. Registered on November 03, 2021.

Telerehabilitation for the treatment in chronic low back pain: A randomized controlled trial.

Although there is growth in the approach to telerehabilitation (TLRH) in different pathologies, research on TLRH for the management of low back pain is scarce and controversial. Thus, the purpose of this study was to analyze whether a TLRH program is as effective as a clinical exercise program in improving pain and different functional variables in patients with nonspecific low back pain (NLBP). A single-blind, two-armed randomized controlled trial was carried out with 68 individuals with chronic NLBP. Participants were randomly allocated to either the TLRH group (TG) (n = 34) or the clinic group (CG) (n = 34). The TG received an exercise-based TLRH video and an educational program on the neurophysiology of pain. The CG received the same pain education and exercise program at the clinic facility supervised by a clinician. Both groups performed 2 weekly sessions for 8 weeks. Active movements of the lumbar spine, pain and range of motion, and kinesiophobia were assessed at baseline, at the end of 8 weeks of treatment, and at 3 months. Statistically significant differences for time-by-group interaction were identified in range of motion of right (F = 11.668; p = 0.001) and left (F = 4.219; p = 0.042) legs when knee extended test is performed; as well as in pain intensity when the same test (F = 5.176; p = 0.043). Moreover, higher pain level during flexion (F = 5.133; p = 0.009) and extension movements (F = 6.335; p = 0.003) in patients with bilateral pain location than those with unilateral or central pain location has been appreciated. A TLRH rehabilitation program via mobile app is as effective as the same exercise program supervised in a clinic.

Effectiveness of Therapeutic Education in Patients with Cancer Pain: Systematic Review and Meta-Analysis.

(1) Objective: To review the existing evidence on pain education in patients with pain derived from an oncological process. (2) Methods: A systematic review was conducted using the databases Pubmed, Web of Science, PEDro, and Scopus. The selected studies had to incorporate instruction about the neurophysiology of pain into their educational program. The target population was cancer patients who had suffered pain for at least one month. The methodological quality of the articles collected was assessed using the PEDro scale. (3) Results: Some 698 studies were initially identified, of which 12 were included in this review. Four different models of pain education programs were found in the studies' interventions. Pain intensity, pain experience, quality of life, pain tolerance, and catastrophism were the variables that appeared most frequently. (4) Conclusions: This review demonstrates that pain education in patients with cancer pain may produce effects such as decreased pain intensity and catastrophism. Knowledge about pain also seems to increase. However, no benefit was reported for patients' overall quality of life. Therefore, more research is needed to clarify the effects of these interventions on the oncology population.

Nociception Effect on Frontal Electroencephalogram Waveform and Phase-Amplitude Coupling in Laparoscopic Surgery.

Electroencephalographic pattern changes during anesthesia reflect the nociception-analgesia balance. Alpha dropout, delta arousal, and beta arousal with noxious stimulation have been described during anesthesia; however, data on the reaction of other electroencephalogram signatures toward nociception are scarce. Analyzing the effects of nociception on different electroencephalogram signatures may help us find new nociception markers in anesthesia and understand the neurophysiology of pain in the brain. This study aimed to analyze the electroencephalographic frequency pattern and phase-amplitude coupling change during laparoscopic surgeries. This study evaluated 34 patients who underwent laparoscopic surgery. The electroencephalogram frequency band power and phase-amplitude coupling of different frequencies were analyzed across 3 stages of laparoscopy: incision, insufflation, and opioid stages. Repeated-measures analysis of variance with a mixed model and the Bonferroni method for multiple comparisons were used to analyze the changes in the electroencephalogram signatures between the preincision and postincision/postinsufflation/postopioid phases. During noxious stimulation, the frequency spectrum showed obvious decreases in the alpha power percentage after the incision (mean ± standard error of the mean [SEM], 26.27 ± 0.44 and 24.37 ± 0.66; P < .001) and insufflation stages (26.27 ± 0.44 and 24.40 ± 0.68; P = .002), which recovered after opioid administration. Further phase-amplitude analyses showed that the modulation index (MI) of the delta-alpha coupling decreased after the incision stage (1.83 ± 0.22 and 0.98 ± 0.14 [MI × 10 3 ]; P < .001), continued to be suppressed during the insufflation stage (1.83 ± 0.22 and 1.17 ± 0.15 [MI × 10 3 ]; P = .044), and recovered after opioid administration. Alpha dropout during noxious stimulation is observed in laparoscopic surgeries under sevoflurane. In addition, the modulation index of delta-alpha coupling decreases during noxious stimulation and recovers after the administration of rescue opioids. Phase-amplitude coupling of the electroencephalogram may be a new approach for evaluating the nociception-analgesia balance during anesthesia.

Investigating the Effect of Pain Neurophysiology Education in the Treatment of Cervicogenic Headache: A Randomized Clinical Trial

Background: Cervicogenic headaches that stem from musculoskeletal disorders of the upper cervical spine are among the most common types of chronic headaches. In recent years, physiotherapy has emerged as a potential treatment for this type of headache. Objectives: Given the emphasis on educational methods such as pain neurophysiology education (PNE) for musculoskeletal pain, the aim of this study is to investigate the effect of PNE in treating cervicogenic headaches. Methods: This study was a single-blind clinical trial. A sample of 30 participants with cervicogenic headache was divided into two groups using the block method: An experimental group of 15 participants and a control group of 15 participants. Experienced physiotherapists provided conventional physiotherapy for 10 sessions, and the experimental group also received pain neurophysiology education for four additional sessions. Pain severity, disability, and pain catastrophizing information were collected using the visual analog scale, headache disability index, and pain catastrophizing scale, respectively, at the beginning of the study, after the study, and at the one-month follow-up. Statistical analysis was conducted using SPSS software version 22, and the significance level was set at 0.05. Results: A significant difference was observed in pain intensity assessment at different times (P &lt; 0.001), headache disability index (P = 0.003), and pain catastrophizing (P &lt; 0.001). The time-by-group interaction was significant for pain intensity (F = 49.051; P &lt; 0.001; ηp2=0.637) and pain catastrophizing (F = 25.528; P &lt; 0.001; ηp2=0.477); however, there was no significant difference in disability (F = 1.781; P = 0.178; ηp2=0.060). Conclusions: Pain neurophysiology education can have a positive effect on pain reduction, as well as the attitude and knowledge of individuals who experience pain in the short term.

In non-specific low back pain, is an exercise program carried out through telerehabilitation as effective as one carried out in a physiotherapy center? A controlled randomized trial

Backgrounds:The effectiveness of telerehabilitation (TLRH) in patients with non-specific low back pain (NLBP) remains unknown. No study till date has investigated the efficacy of a mobile-based TLRH in patients with NLBP. ObjectivesTo investigate if a TLRH program is as effective as a clinical exercise programme in improving disability, pain intensity, pain catastrophizing, and hip pain and strength in patients with NLBP. DesignSingle-blind, two-armed, randomized controlled study. MethodA total of 71 individuals with NLBP were randomly allocated to either the TLRH home group (TLRH) or clinic group (CG). The TLRH followed exercise videos and read information on pain neurophysiology. The CG performed the same exercises and received on-site pain education. Both groups performed the exercises twice weekly for 8 weeks. Disability, pain intensity, pain catastrophizing, and hip pain and strength were assessed at baseline, at post-treatment, and at three months. ResultsStatistically significant differences for time-by-group interaction were detected in the strength of left hip flexors (supine [F = 8.356; p = .005]; sitting [F = 9.828; p = .003]), right hip extensors with extended knee [F = 7.461; p = .008], left hip extensors (extended knee [F = 13.175; p = .001]; flexed knee [F = 13.505; p < .001]), pain during flexion of the right [F = 5.133; p = .027] and left [F = 4.731; p = .033] hips in the supine position, disability [F = 4.557; p = .014], and pain catastrophizing [F = 14.132; p < .001]. ConclusionA TLRH mobile-based is as effective as clinical treatment in improving disability, pain catastrophizing, and pain and strength of the hip structures in patients with NLBP.

Assessment and management of pain/nociception in patients with disorders of consciousness or locked-in syndrome: A narrative review.

The assessment and management of pain and nociception is very challenging in patients unable to communicate functionally such as patients with disorders of consciousness (DoC) or in locked-in syndrome (LIS). In a clinical setting, the detection of signs of pain and nociception by the medical staff is therefore essential for the wellbeing and management of these patients. However, there is still a lot unknown and a lack of clear guidelines regarding the assessment, management and treatment of pain and nociception in these populations. The purpose of this narrative review is to examine the current knowledge regarding this issue by covering different topics such as: the neurophysiology of pain and nociception (in healthy subjects and patients), the source and impact of nociception and pain in DoC and LIS and, finally, the assessment and treatment of pain and nociception in these populations. In this review we will also give possible research directions that could help to improve the management of this specific population of severely brain damaged patients.

European Cancer Summit 2022 submission for Survivoship and Quality of Life NetworkEffect of Pain Neuroscience Education after breast cancer surgery on pain, physical and psychosocial functioning: a double-blinded randomized controlled trial (EduCan trial)

BackgroundApproximately one in five women experiences persistent pain after breast cancer surgery. Despite the effectiveness of different physical therapy modalities (e.g., manual therapy, physical activity), pain and associated limitations in daily functioning remain common. Recently, there has been a greater awareness of the role of education in the treatment of pain. The goal of educational interventions is to help patients better understand, manage and cope with their pain. Currently, these are often limited to instruction based on a more biomedical approach to pain and the administration of pain medications. Increased understanding of the neurophysiology of pain resulted in a different educational approach. Pain neuroscience education (PNE) aims to reconceptualize pain away from the biomedical model towards a biopsychosocial understanding, in order to decrease the threat value of pain. This double-blinded randomized controlled trial investigated whether PNE, in addition to best-evidence physiotherapy after breast cancer surgery, was more beneficial than biomedical education on pain-related, physical and psychosocial functioning. MethodsThree educational sessions were given in addition to a four-month physiotherapy program starting immediately postoperative. The content of the educational interventions differed between the intervention (PNE, n=92) and control group (biomedical pain education, n=92). Additional educational and physiotherapy sessions were provided at six, eight and twelve months postoperatively. The primary outcome was the change in pain-related disability (Pain Disability Index) after twelve months. Secondary outcomes were pain intensity, upper limb function, physical activity and psychosocial functioning. All outcomes were evaluated pre-and postoperatively, and at four, six, eight, twelve and eighteen months. ResultsChange in pain-related disability from baseline to twelve months postoperatively did not differ between groups (p=0.525). Secondary outcomes yielded similar results. ConclusionsAdding six sessions of PNE to physiotherapy immediately after breast cancer surgery did not result in a better course of functioning up to eighteen months postoperatively as compared to biomedical pain education. This finding broadens our understanding of PNE in this population and provides the basis for future research to fine-tune the optimal delivery format. Instead of imposing a one-size-fits-all formula, future research should investigate the effectiveness of a more patient-tailored PNE approach, based on a patient's specific needs and readiness.

Assessment of knowledge about the neurophysiology of pain and self-perception of skills to assist individuals with pain among undergraduate physiotherapy students in Brazil: cross-sectional study

Assessment of knowledge about the neurophysiology of pain and self-perception of skills to assist individuals with pain among undergraduate physiotherapy students in Brazil: cross-sectional study

Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain?

This systematic review and meta-analysis aimed to determine the association between changes in patients' pain knowledge after pain science education (PSE) with treatment outcomes in people with chronic pain. Six electronic databases and 2 clinical trial registries were searched from inception to September 15, 2021 for studies where participants received PSE and had their pain knowledge and clinical outcomes assessed before and after PSE. Meta-analyses were performed for pain intensity, kinesiophobia, and pain catastrophizing. Physical function and quality of life outcomes were synthesized narratively. Risk of bias was assessed using the Cochrane tool for nonrandomized studies and the quality of evidence was assessed using GRADE. Fourteen studies (n=1500 participants) were included. Meta-analyses revealed no significant associations between short-term (<12wk) changes in pain neurophysiology knowledge with changes in pain intensity (n=1075, r=-0.01, 95% CI =-0.14 to 0.13, very low certainty), kinesiophobia (n=152, r=0.02, 95% CI =-0.27 to 0.24, very low certainty) and pain catastrophizing (n=976, r=-0.03, 95% CI=-0.18 to 0.11, low certainty). No significant associations were found between short-term changes in pain neurophysiology knowledge and physical function or quality of life either. These findings do not support a short-term association between improvements in pain neurophysiology knowledge and better treatment outcomes in people with chronic pain. Increased understanding of how PSE works, as well as better ways to measure it, may help clinicians deliver more targeted education to help patients reconceptualize pain and promote engagement in active treatment strategies (eg, exercise).

Physiotherapeutic treatment associated with the pain neuroscience education for patients with chronic non-specific low back pain-single-blind randomized pilot clinical trial.

Pain Neuroscience Education (PNE) shows improvement in pain and functional capacity in patients with chronic low back pain (CLBP). Therefore, the study aimed to verify if the physiotherapeutic treatment associated with PNE decreases the functional disability of patients with nonspecific CLBP. Forty patients were clinically evaluated and answered the following questionnaires: Brief pain inventory, Central Sensitization Inventory (CSI), Roland-Morris disability questionnaire, pain catastrophizing scale, Tampa scale of kinesiophobia, hospital anxiety, and depression scale, SF6D quality of life questionnaire and performed quantitative sensory tests (QSTs). Afterward, they were randomly divided into the intervention group (IG, n=20) and the control group (CG, n=20). Both performed kinesiotherapy exercises twice a week for 6 weeks. The IG received 3 individual PNE sessions and answered the pain neurophysiology questionnaire. IG showed significant improvement for all variables analyzed (p<0.001). The association decreased the kinesiophobia (estimated difference between CG-IG means: 7.6-95% CI: 2.3-12.9) (p=0.006). In the lumbar paravertebral region (CG and IG), there was a statistical difference in the intensity of CLBP in the QSTs (p<0.05). The association showed better results compared to only therapeutic exercises to reduce kinesiophobia and change the perception of pain intensity in the lumbar region.

Alternatives to opioids for managing chronic pain: a patient education programme in the US

As the US is experiencing an opioid epidemic, patients with non-malignant chronic pain must understand the risks of opioids and identify safe and effective treatment alternatives. Multidisciplinary pain management programmes have been shown to be effective in reducing non-malignant chronic pain. A pilot project was conducted in a primary care clinic in the US with the aim of educating patients on the neurophysiology of pain, biopsychosocial responses to pain, risks and benefits of opioids and non-opioid alternatives, and pain management techniques. The programme was shown to be associated with use of reduced amounts of opioids, reduced catastrophising and reduced pain among the 13 participants. After the programme, participants reported having a better understanding of pain and pain management and being willing to work with primary care clinicians to decrease their use of opioids. Programmes that teach patients how to manage chronic pain and reduce opioid use are crucial to addressing the opioid epidemic in the US.