The Effects of a Pain Psychology and Neuroscience Self-Evaluation Internet Intervention

Abstract

Objectives: Many patients’ chronic musculoskeletal pain is strongly influenced by central nervous system processes such as sensitization or amplification. Education about pain neuroscience can change patients’ beliefs but has less consistent effects on pain outcomes. Patients may have greater clinical benefits if the educational intervention is personalized, and they evaluate various psychosocial risk factors with respect to their pain. We developed and tested a brief, internet-based Pain Psychology and Neuroscience (PPN) self-evaluation intervention. Materials and Methods: From a patient registry, 104 adults reporting chronic musculoskeletal pain were randomized to the PPN intervention or a matched, active, education control condition. At baseline and 1-month (primary endpoint) and 10-month follow-ups, participants reported pain severity (primary outcome) and multiple secondary outcomes. Primary analyses compared the 2 experimental conditions using analyses of covariances; post hoc exploratory analyses compared the effects of PPN in subgroups of patients who met criteria for fibromyalgia (FM; n=50) or who did not (n=54; primarily spinal pain). Results: At 1-month follow-up, compared with the control condition, PPN led to significantly lower pain severity (ηp 2=0.05) and interference (ηp 2=0.04), greater brain (ηp 2=0.07) and psychological (ηp 2=0.07) attributions for pain, and greater readiness for pain self-management (ηp 2=0.08). Effects on distress, pain catastrophizing, kinesiophobia, and life satisfaction were not significant. Exploratory analyses showed that the PPN intervention was especially beneficial for patients without FM but was of less benefit for those with FM. Most of the effects (except attributions) were lost at 10 months. Discussion: A brief PPN self-evaluation intervention, presented on-line, can yield short-term improvements in musculoskeletal pain severity and interference, especially for people with spinal/localized pain rather than FM, perhaps because the psychology/neuroscience perspective is more novel for such patients.

Trauma matters: psychological interventions for comorbid psychosocial trauma and chronic pain

“…15,42,68 We recommend that treatments of comorbid trauma/CP include pain neuroscience, linking both trauma and CP to brain processes and emphasizing neural plasticity and the possibility of treating-rather than just managing-both trauma and pain disorders. 50,59…”

Online pain management programs for chronic, widespread musculoskeletal conditions: A systematic review with meta‐analysis

“…A final 18 articles were included and the selection process with exclusion reasons detailed in the PRISMA flowchart (Figure 1). [41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Characteristics of the included studies are detailed in Table 1. Majority of participants were female (average 83%).…”

“…Completion rates (defined as finishing all or a predetermined percentage of modules) were reported across six studies. 44,45,48,52,53,58 Intervention group completion rates ranged from 49% to 100%, while the control groups ranged from 63% to 100% completion. 44,48 Overall, completion rates varied, but were comparable between online pain management and control groups.…”

“…44,45,48,52,53,58 Intervention group completion rates ranged from 49% to 100%, while the control groups ranged from 63% to 100% completion. 44,48 Overall, completion rates varied, but were comparable between online pain management and control groups. Participant feedback (acceptability, satisfaction, and helpfulness) Participant feedback was measured diversely with helpfulness, satisfaction, and acceptability most commonly reported.…”

“Pain, Stress, and Emotions”: Uncontrolled trial of a single-session, telehealth, emotional awareness and expression therapy class for patients with chronic pain

“…The first hour focused on: (a) pain psychology and neuroscience education, including the role of the brain in pain; (b) the limitations of imaging for identifying bodily sources of pain; (c) the model of chronic pain as often being a "false danger alarm" that can be triggered not only by fear of injury or pain but also of other psychosocial threats; and d) how to "teach the brain safety by reversing avoidance of fear-inducing experiences. We also presented four brief exercises from Kohns et al (2020) (22) to help patients examine the role that stress and emotions play in their pain and to personalize their learning: (a) various central sensitization conditions/symptoms they have had, (b) personality traits or emotional needs that create anxiety, (c) life stressors that often trigger or exacerbated pain, and (d) the 10-item Adverse Childhood Experiences Scale. Participants responded to these exercises by placing answers in the chat or holding up fingers or hands; that is, sharing their answers with group members and leaders.…”