Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis

Abstract

Purpose To assess the effects of pain neuroscience education (PNE) on patients with fibromyalgia (FM) in terms of pain intensity, fibromyalgia impact, anxiety, and pain catastrophizing. Methods A systematic review and meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated with RStudio software for relevant outcomes and were pooled in a meta-analysis using the random effects model. Results A total of 8 studies were included. The meta-analysis showed statistically significant differences in the pain intensity with a moderate clinical effect in 7 studies in the post-intervention assessment (SMD:-0.76; 95% CI:-1.33– -0.19; p < 0.05) with evidence of significant heterogeneity (p < 0.05, I2=92%) but not in fibromyalgia impact, anxiety, and pain catastrophizing (p > 0.05). Regarding the follow-up assessment, only the fibromyalgia impact showed significant improvements with a very small clinical effect in 9 studies (SMD:-0.44; 95% CI:-0.73– -0.14; p < 0.05) with evidence of significant heterogeneity (p < 0.05, I2 = 80%). Applying a sensitivity analysis with the PNE face-to-face interventions, the meta-analysis showed a significant decrease of pain intensity with a moderate clinical effect at post-intervention and follow-up without evidence of significant heterogeneity (p < 0.05, I2=10%). Conclusions There is low quality evidence that in patients with FM, PNE can decrease the pain intensity post-intervention and also the fibromyalgia impact in the follow-up. However, it appears that PNE showed no effect on anxiety and pain catastrophizing.

Relación de las variables de catastrofismo y autoeficacia con la intensidad del dolor, la función y la discapacidad en pacientes de artrosis de rodilla y cadera: una revisión sistemática

“…Por otro lado, las intervenciones dirigidas a mejorar la monitorización del dolor y optimizar el manejo analgésico en un grupo de pacientes con dolor crónico de diferentes características, mostraron la reducción de los síntomas depresivos, el catastrofismo y la ansiedad como predictores de la reducción en la intensidad del dolor y la discapacidad relacionada con el dolor en el seguimiento (Scott et al, 2016). Estrategias basadas en la educación terapéutica han demostrado ser eficaces en la reducción de la intensidad del dolor y mejora de la discapacidad en dolor lumbar crónico y fibromialgia, pudiendo ser útiles en futuras aplicaciones para pacientes de artrosis de cadera y rodilla (Pires et al, 2015;Suso-Martí et al, 2022). Sin embargo, no parece que esta reducción en el dolor venga acompañada de una reducción en el catastrofismo en los estudios en pacientes de fibromialgia (Suso-Martí et al, 2022).…”

“…Estrategias basadas en la educación terapéutica han demostrado ser eficaces en la reducción de la intensidad del dolor y mejora de la discapacidad en dolor lumbar crónico y fibromialgia, pudiendo ser útiles en futuras aplicaciones para pacientes de artrosis de cadera y rodilla (Pires et al, 2015;Suso-Martí et al, 2022). Sin embargo, no parece que esta reducción en el dolor venga acompañada de una reducción en el catastrofismo en los estudios en pacientes de fibromialgia (Suso-Martí et al, 2022). Es posible que los efectos en el dolor se deban a la modificación de otras variables que deban ser analizadas en futuros estudios sobre educación terapéutica.…”

Comment on: Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta‐analysis

“…The SR/MA by Suso-Martí et al extracted the follow-up results from 8 RCTs and discovered a noteworthy phenomenon. 3 Although the patients with fibromyalgia showed a short-term improvement on some aspects of the Fibromyalgia Impact Questionnaire, some of the results manifest no improvement after a follow-up assessment a few months later. In other words, PNE might benefit fibromyalgia patients in the short term, but not in the long term.…”

“…First, the authors selected only 4 studies in their SR/MA, which they admitted as a limitation; nevertheless, we found an SR/MA with a similar topic which includes 8 studies. 3 After comparing the searching strategies, Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagrams, and the selected RCTs of the 2 SR/ MAs, we consider that the authors of the former SR/MA excluded some RCTs not because their selection was rather strict, but because their searching strategy did not include enough synonyms for fibromyalgia and PNE. For example, 2 RCTs selected in the latter SR/MA titled "How Much Is Needed?…”

Reply to “Comment on effectiveness of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta‐analysis”

“…First, our study 2 aimed to evaluate whether adding PNE to a multimodal approach has additional benefits in patients with FM. The SR/MA 3 differs from our study 2 in terms of the aim and eligibility criteria, intervention and comparison criteria. For example, the intervention methods used in our study 2 were defined as multimodal.…”