Behavior Change Following Pain Neuroscience Education in Middle Schools: A Public Health Trial

Abstract

Chronic pain and the opioid epidemic need early, upstream interventions to aim at meaningful downstream behavioral changes. A recent pain neuroscience education (PNE) program was developed and tested for middle-school students to increase pain knowledge and promote healthier beliefs regarding pain. In this study, 668 seventh-grade middle-school students either received a PNE lecture (n = 220); usual curriculum school pain education (UC) (n = 198) or PNE followed by two booster (PNEBoost) sessions (n = 250). Prior to, immediately after and at six-month follow-up, pain knowledge and fear of physical activity was measured. Six months after the initial intervention school, physical education, recess and sports attendance/participation as well as healthcare choices for pain (doctor visits, rehabilitation visits and pain medication use) were measured. Students receiving PNEBoost used 30.6% less pain medication in the last 6 months compared to UC (p = 0.024). PNEBoost was superior to PNE for rehabilitation visits in students experiencing pain (p = 0.01) and UC for attending school in students who have experienced pain > 3 months (p = 0.004). In conclusion, PNEBoost yielded more positive behavioral results in middle school children at six-month follow-up than PNE and UC, including significant reduction in pain medication use.

Development of the Conceptualization of Pain Questionnaire: A Measure to Study How Children Conceptualize Pain

“…Although other measures can be used to assess an individual’s concept of pain, the COPAQ responds to the need for a pediatric version [ 37 ]. Importantly, it is quite different from another similar measure (COPI; [ 39 ]) in major ways.…”

“…For example, the revised Neurophysiology of Pain Questionnaire [ 34 ] was devised to be used with adults, and has proved to be a useful tool for studying the conceptualization of the biological mechanisms underlying pain, and the effects of educational interventions on patients’ pain experience [ 20 , 35 , 36 ]. Louw et al [ 37 ] used this questionnaire as the assessment tool for one programme of education in the neurophysiology of pain in children aged 12 years old.…”

Pain science education for children living with and beyond cancer: Challenges and research agenda

“…22 According to a recent Cochrane report, there is no evidence to support or refute the use of opioids for treating cancer-related pain in children and adolescents, 21 highlighting the importance of nonpharmacological pain management strategies. One nonpharmacological treatment approach increasingly researched and implemented in pediatric and adolescent clinical 43,44 and nonclinical [45][46][47][48] populations is pain science education (PSE). PSE, also called pain neuroscience education, 49 explains pain, 50 therapeutic neuroscience education 51,52 or pain education, 53 is a conceptual change strategy facilitating patients' understanding of the biopsychosocial aspects of pain, including the contributing role of (neuro)physiological, psychosocial, and environmental factors.…”

“…PSE comprises one or more patient-tailored educational sessions, typically face-to-face between a therapist and patient, and supported by educational materials. Evidence in children and adolescents in clinical 43,44 and nonclinical [45][46][47][48] settings shows that PSE results in increased pain knowledge, 43,[45][46][47][48][55][56][57] more functional pain beliefs, 46,56,57 less catastrophic worry about pain, 58 less pain-related fear, 44 less functional disability, 44 less medication use, 45 higher pain thresholds, 44,48 higher school attendance, 45 and decreased fear of physical activity. 56 There is less evidence that PSE for both adults and children results in reduced pain intensity, 43,44,59 pressure pain thresholds, 60,61 or anxiety.…”

Pain Neuroscience Education: „Schmerz SoS – Schurke oder Superheld?“

“…Evidenz Für PNE-Programme bei Erwachsenen besteht Evidenz: Sie kann nicht nur die Schmerzen und den Grad der Einschränkungen positiv beeinflussen, sondern auch das Angstvermeidungsverhalten, Katastrophisierung, Funktionsseinschränkungen sowie das Wissen hinsichtlich der Schmerzen und die Inanspruchnahme von Gesundheitsleistungen 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 .…”