Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial

Abstract

Chronic low back pain that lasts more than 12 weeks causes mental and physical distress. This study investigated the effects of pain neuroscience education combined with lumbar stabilization exercises on strength, pain, flexibility, and activity disorder index in female patients with chronic low back pain. Thirty-five female patients with chronic low back pain were randomly divided into two groups: the pain neuroscience education (PNE) combined with lumbar stabilization exercises (LSEs) group (n = 18, experimental group) and the lumbar stabilization exercises alone group (n = 17, control group). The experimental group underwent PNE combined with LSEs for 30 min per session, twice per week for 8 weeks, and the control group underwent LSEs only. The primary outcomes were strength (sit-up and back-up movements), Numerical Pain Rating Scale (NPRS), Korean Pain Catastrophizing Scale (K-PCS), and Tampa Scale of Kinesio-phobia-11 (TSK-11) for pain. The secondary outcomes were modified–modified Schober’s test (MMST) and finger to floor test (FFT) for flexibility and activity disorder (Roland–Morris Disability Questionnaire index). A significant difference was observed in the primary outcomes after intervention in the abdominal muscle strength (group difference, mean, −7.50; 95% CI, −9.111 to –5.889, F = 9.598; ANCOVA p = 0.005), the back muscle strength (group difference, mean, −9.722; 95% CI, −10.877 to –8.568, F = 7.102; ANCOVA p = 0.014), the NPRS (group difference, mean, 1.89; 95% CI,1.65 to 2.12, F = 24.286; ANCOVA p < 0.001), K-PCS (group difference, mean, 7.89; 95% CI, 7.02 to 8.76, F = 11.558; ANCOVA p = 0.003), and TSK-11 (group difference, mean, 16.79; 95% CI, 13.99 to 19.59, F = 13.179; ANCOVA p = 0.014) for pain. In the secondary outcomes, there was a significant difference in the FFT (group difference, mean, −0.66; 95%CI, −0.99 to −0.33, F = 4.327; ANCOVA p = 0.049), whereas the difference in flexibility (MMST) and activity disorder index of the secondary outcomes did not reach significance. Therefore, this study confirmed that PNE combined with LSEs is an effective intervention compared to LSE alone in improving muscle strength and pain in female patients with chronic low back pain.

Effectiveness of a Group-Based Rehabilitation Program Combining Education with Multimodal Exercises in the Treatment of Patients with Nonspecific Chronic Low Back Pain: A Retrospective Uncontrolled Study

“…The reductions in pain intensity and functional disability observed in our patient series (2.3 and 4.9 points) compare well with those reported by Kim et al [ 42 ] (1.9 and 3.9 points, respectively) on a comparable group of NSCLBP patients who followed an individual program combining education and lumbar stabilization exercise. Likewise, Pires et al [ 43 ] reported a comparable pain intensity reduction of 2.3 points at 6 weeks, although only 59% of their patients achieved a change beyond the MCID.…”

Task-specific fear rather than general kinesiophobia assessment is associated with kinematic differences in chronic low back pain during lumbar flexion: a preliminary investigation

“…Compared with subjects of previous studies, the TSK-11 scores or pain intensity of our subjects were somewhat lower; therefore, all kinematic data might not be significantly correlated with the TSK-11 scores. 17 , 31 Second, in the case of a longitudinal intervention, there is a need to assess fear before and after a movement or task so that fear-avoidance beliefs or expectations and the fear of the movement can be confirmed. 25 In addition, kinesiophobia and pain factors related to the lumbar movement were not assessed after the practice trials.…”

Biomechanical Asymmetry of Strength and Dynamic Balance Kinetics in Middle-Ages with Adhesive Capsulitis of the Hip

“…Three main factors contribute to muscle strength. Muscle strength is proportional to muscle cross-sectional area and neuromuscular activity and inversely proportional to pain [ 22 , 23 ]. The significantly lower muscle strength in this study was probably due to an increase in pain rather than a decrease in muscle cross-sectional area.…”