The clinical impact of pain neuroscience continuing education on physical therapy outcomes for patients with low back and neck pain

Abstract

Objectives Research suggests that attendance by physical therapists at continuing education (CE) targeting the management of low back pain (LBP) and neck pain does not result in positive impacts on clinical outcomes. The aim of this study was to determine if therapists attending a self-paced 3-hour online Pain Neuroscience Education (PNE) program was associated with any observed changes to patient outcomes and also clinical practice. Methods Participants were 25 different physical therapists who treated 3,705 patients with low back pain (LBP) or neck pain before and after they had completed an online PNE CE course. Change in outcomes measures of pain and disability at discharge were compared for the patients treated before and after the therapist training. Clinical practice patterns of the therapists, including total treatment visits, duration of care, total units billed, average units billed per visit, percentage of ‘active’ billing units and percentage of ‘active and manual’ billing units, were also compared for the patient care episodes before and after the therapist training. Results There was no significant difference for change in pain scores at discharge for patients treated after therapist CE training compared to those treated before regardless of the condition (LBP or neck pain). However, patients with LBP who were treated after therapist CE training did report greater improvement in their disability scores. Also after CE training, for each episode of care, therapists tended to use less total visits, billed fewer units per visit, and billed a greater percentage of more ‘active’ and ‘active and manual’ billing units. Discussion Attending an online 3-hour CE course on PNE resulted in improved disability scores for patients with LBP, but not for those with neck pain. Changes in clinical behavior by the therapists included using less visits, billing fewer total units, and shifting to more active and manual therapy interventions. Further prospective studies with control groups should investigate the effect of therapist CE on patient outcomes and clinical practice.

Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta‐analysis of randomized controlled trials

“…Of 787 non‐duplicated citations identified in the literature, 19 were further analysed to confirm their eligibility. Twelve were excluded after full‐text reading: four as they included participants with concurrent low back pain (Bilterys et al, 2022; Malfliet, Kregel, Coppieters, et al, 2018; Malfliet, Kregel, Meeus, Roussel, et al, 2018; Van Bogaert et al, 2021), two for not being RCTs (Jessica Van Oosterwijck et al, 2011; Louw et al, 2022), one for not reporting pain intensity and kinesiophobia (Willaert et al, 2020), two for lacking control groups and not using PNE (Brage et al, 2015; Ris et al, 2016), two for using the bio‐behavioural approach instead of PNE (Beltran‐Alacreu et al, 2015; López‐de‐Uralde‐Villanueva et al, 2018), and one for having participants overlapping with another publication by the author (Neto et al, 2018). The reasons for exclusion are listed in Table S3.…”

Variables associated with nonresponders to high‐frequency (10 kHz) spinal cord stimulation

“…Although our study found no statistically significant association between the groups, we concur with the literature that psychological screening is required to guide better patient selection, and if needed psychological treatment prior to SCS trial and implantation is necessary to reduce confounding variables to SCS response. Pain neuroscience patient education and treatment on psychological factors have been associated to improve chronic pain, disability, and multidisciplinary treatment outcomes prior to surgical interventions 82,83 …”

“…Pain neuroscience patient education and treatment on psychological factors have been associated to improve chronic pain, disability, and multidisciplinary treatment outcomes prior to surgical interventions. 82,83 History of spinal surgery…”

Pain Neuroscience Education for Acute Pain

“…They also tend to employ less provocative biomedical language and approaches when addressing pain, adjust their clinical practices to better treat individuals in pain, and ultimately achieve better patient outcomes. 13,32,33 Second, and perhaps of greater significance, studies have demonstrated that enhancements in pain knowledge among patients have a beneficial impact on various aspects including self-reported pain ratings, disability, fear and fear-avoidance, pain catastrophizing, willingness and ability to move, as well as healthcare expenditures. [7][8][9] For athletes this is very important, since pain, fear and catastrophizing all have the potential to impact movement, performance, motor control, concentration, which are essential for optimial performance.…”