Comparing Pain Neuroscience Education Followed by Motor Control Exercises With Group‐Based Exercises for Chronic Low Back Pain: A Randomized Controlled Trial

Abstract

Background: Different individualized interventions have been used to improve chronic low back pain (CLBP). However, their superiority over group-based interventions has yet to be elucidated. We compared an individualized treatment involving pain neuroscience education (PNE) plus motor control exercise (MCE) with group-based exercise (GE) in patients with CLBP. Methods: Seventy-three patients with CLBP were randomly assigned into the PNE plus MCE group (n = 37) and GE group (n = 36). Both PNE plus MCE and GE were administered twice weekly for 8 weeks. Pain intensity (as measured using the VAS), disability (as measured using the Roland-Morris Disability Questionnaire), fear-avoidance beliefs (as measured using the Fear-Avoidance Beliefs Questionnaire), and selfefficacy (as measured using the Pain Self-Efficacy Questionnaire) were assessed at baseline and 8 weeks post-intervention. A 2 9 2 variance analysis (treatment group 9 time) with a mixed-model design was applied to statistically analyze the data. Results: Both groups showed significant improvements in all the outcome measures, with a large effect size (P < 0.001, partial eta squared [gp 2 ] = 0.66 to 0.81) after the intervention. The PNE plus MCE group showed greater improvements, with a moderate effect size in pain intensity (P = 0.041, gp 2 = 0.06) and disability (P = 0.021, gp 2 = 0.07) compared to the GE group. No significant difference was found in fearavoidance beliefs during physical activity and work, and selfefficacy (P > 0.05) between the 2 groups. Conclusion: PNE and MCE seem to be better at reducing pain intensity and disability compared to GE, while no significant differences were observed for fear-avoidance beliefs and self-efficacy between the 2 groups in patients with CLBP. With regard to the superiority of individualized interventions over group-based ones, more studies are warranted. &

Psychological interventions for chronic, non-specific low back pain: systematic review with network meta-analysis

“…Of these studies, 12 (60%) clearly reported that no adverse events occurred in any intervention group. 55 67 76 82 85 89 90 95 96 97 98 99 One study comparing cognitive behavioural therapy with no intervention reported that no serious adverse effects (defined as death or admission to hospital, events attributable to the intervention, or events that caused unwarranted distress to a participant) occurred in either group, during the intervention period. 47 Four studies reported on the occurrence of adverse events during the intervention period 54 61 100 101 ; however, none was related to the psychological interventions under investigation.…”

Pain Neuroscience Education and Motor Control Exercises versus Core Stability Exercises on Pain, Disability, and Balance in Women with Chronic Low Back Pain

“…Additionally, the comparison of the two exercise programs showed a greater effect of motor control with cognitive purpose compared to the core stability exercises on the variables of pain and disability (VAS and RMDQ, respectively). A possible justification could be associated with the individualized, PNE treatment employed using cognitive-based education followed by an exercise program as previously suggested [ 21 ].…”

“…In addition, more knowledge of spinal motor dysfunction in patients with CLBP has emerged [ 16 , 17 ]. Patients with CLBP that present reduced motor control usually have difficulties to control postures and movements [ 16 , 18 ].Therefore, addressing pain recognition and a better spinal muscle function to improve spinal motor control could be more effective [ 19 , 20 , 21 ].…”

Pain Education in the Management of Patients with Chronic Low Back Pain: A Systematic Review

“…Based on the results from the PEDro scale data, almost all studies were judged to be at low risk of bias for most of the items. Two studies were considered at high evidence level (level I) [ 21 , 23 ], nine studies at evidence level II [ 11 , 12 , 13 , 15 , 16 , 17 , 19 , 20 , 22 ] and two (one of which has a quasi-experimental design) with a low level of evidence [ 14 , 15 ].…”

“…The results of the 13 studies were discussed separately, depending on the outcome measures investigated. According to pain reduction, investigated through VAS, NRS, NRS-11, PBI and CPAQ, six studies [ 11 , 12 , 14 , 18 , 19 , 23 ] out of thirteen significantly supported more evidence in the experimental group than in the control group. Moreover, in favor of the experimental group and to the detriment of the control group, another study [ 23 ] showed modest improvements, and one [ 17 ] showed a moderate reduction in painful symptoms detected after surgery, but which was not maintained at subsequent endpoints of follow-up.…”