Neurophysiological Pain Education for Patients with Chronic Low Back Pain

TY - JOUR

T1 - Neurophysiological Pain Education for Patients with Chronic Low Back Pain

AU - Tegner, Heidi

AU - Frederiksen, Pernille

AU - Esbensen, Bente A.

AU - Juhl, Carsten

PY - 2018

Y1 - 2018

N2 - Objective: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). Methods: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Results: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=-1.03 (95% confidence interval [CI],-0.55 to-1.52), and after 3 months, WMD=-1.09 (95% CI,-2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=-0.47 (95% CI,-0.80 to-0.13) and after 3 months SMD=-0.38 (95% CI,-0.74 to-0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=-5.73 (95% CI,-13.60 to 2.14) and after 3 months WMD=-0.94 (95% CI,-6.28 to 4.40). Discussion: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.

AB - Objective: To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP). Methods: A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines. Results: Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=-1.03 (95% confidence interval [CI],-0.55 to-1.52), and after 3 months, WMD=-1.09 (95% CI,-2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=-0.47 (95% CI,-0.80 to-0.13) and after 3 months SMD=-0.38 (95% CI,-0.74 to-0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=-5.73 (95% CI,-13.60 to 2.14) and after 3 months WMD=-0.94 (95% CI,-6.28 to 4.40). Discussion: There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.

KW - education

KW - low back pain

KW - neurophysiology

KW - systematic review

U2 - 10.1097/AJP.0000000000000594

DO - 10.1097/AJP.0000000000000594

M3 - Review

C2 - 29443723

AN - SCOPUS:85050018366

SN - 0749-8047

VL - 34

SP - 778

EP - 786

JO - Clinical Journal of Pain

JF - Clinical Journal of Pain

IS - 8

ER -