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

Abstract

Objective: 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.Methods: 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.Results: Fourteen studies (n = 1500 participants) were included. Metaanalyses revealed no significant associations between short-term (< 12 wk) 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.Discussion: 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).

Association of Kinesiophobia with Catastrophism and Sensitization-Associated Symptoms in COVID-19 Survivors with Post-COVID Pain

“…Deciding when to address these cognitive behaviors in clinical practice remains unclear, and probably they should be managed at the same time as biological factors associated with long COVID. In fact, a recent meta-analysis concluded that the clinical effects of isolated interventions, such as pain neuroscience education, are smaller than expected, at least in the short-term [60]. Since cognitive factors including kinesiophobia and pain catastrophizing are associated with sensitization-associated symptoms, clinicians should consider multimodal individually tailored treatments, combining pain neuroscience education with physical therapy and stress management.…”

Perspectives on emotional memory images and the persistence of pain

“…Lumley et al ( 26 ) argue that trauma is treated to facilitate remission or recovery, whereas persistent pain is managed so that a person is better able to function with pain. Thus, Lumley et al advocate pain science education to promote understanding of the role of brain processing (bioplasticity) in linking trauma and persistent pain, thus aiding recovery; meta-analyses evaluating the efficacy of pain science education are inconclusive due to a paucity of large robust clinical trials ( 27 , 28 ).…”