Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education

Abstract

Pain neuroscience education (PNE) is an educational strategy aimed at teaching people more about pain from a neurobiological and neurophysiological perspective. Current best-evidence provides strong support for PNE to positively influence pain ratings, dysfunctions, fear-avoidance and pain catastrophization, limitations in movement, pain knowledge, and healthcare utilization. To date, all PNE studies have been conducted on adult populations. This study set out to explore if an abbreviated PNE lecture to middle school children would result in a positive shift in pain knowledge as well as healthier beliefs regarding pain. One-hundred-and-thirty-three middle school students spanning 5th to 8th grade attended a 30-minute PNE lecture. The primary outcome measures of pain knowledge (neurophysiology of pain questionnaire [NPQ]) and beliefs regarding pain (numeric rating scale) were measured before and immediately after the PNE lecture. Significant improvement in knowledge was found with mean score on NPQ test scores improving from 3.83 (29.5%) pre-PNE to 7.90 (60.8%) post-PNE (p < 0.001), with a large effect size (r = .711). Significant shifts in beliefs were also found in all but one of the pain beliefs questions, with a medium effect size for "you can control how much pain you feel" (p < 0.001; r = 0.354) and large effect size for "your brain decides if you feel pain, not your tissues" (p < 0.001; r = 0.545). This study shows that a 30-minute PNE lecture to middle school children resulted in a significant increase in their knowledge of pain as well various beliefs regarding pain.

Talking to Teens about Pain: A Modified Delphi Study of Adolescent Pain Science Education

“…17,18 There is limited evidence investigating pain science education in adolescents. To date, three school-based studies have demonstrated that adolescents have the capacity to learn pain science topics via a 30-minute lecture, 19 an 11-minute video, 20 and a four-week classroom-style intervention. 21 The classroom intervention study is the only randomized controlled trial, investigating the effects of adolescent pain science education, by combining education with neck exercises for chronic neck pain.…”

A Randomized Trial of Live versus Video Delivery of Pain Neuroscience Education for Middle School Children

“…Up to 25% of individuals under the age of 19 have experienced pain in the last three months, with "intense and frequent" pain being reported in 6-8% of all children [1,2]. Furthermore, 92.5% of middle school students reported knowing someone living with persistent pain [3].…”

“…Recently the food and drug administration (FDA) published guidelines for dosing of extended release oxycodone for children as young as eleven years old [7]. The need for effective treatment of pediatric pain is self-evident: children in pain can become adults in pain, risking a staggering emotional, economic and societal burden [3,8,9]. These adolescent and child statistics pertaining to pain and opioid exposure/use are part of the current pain and opioid epidemic in the United States (US) and globally [10].…”

“…Throughout the history of mankind, whenever faced with epidemics, i.e., tobacco use (smoking), human immunodeficiency virus (HIV), etc., mass education has been utilized as a means to mobilize society. One non-pharmacological intervention addressing pain and the opioid epidemic that is gaining interest and holds potential to curb the rise in chronic pain and disability, as well as opioid use in adolescents, is pain neuroscience education (PNE) [3]. In people with musculoskeletal pain it has been demonstrated that educational strategies focused on the neurophysiology and neurobiology of pain (PNE) have strong evidence for improving pain ratings, pain knowledge, disability, pain catastrophization, fear-avoidance, attitudes and behaviors regarding pain, physical movement and healthcare utilization [11].…”

“…In people with musculoskeletal pain it has been demonstrated that educational strategies focused on the neurophysiology and neurobiology of pain (PNE) have strong evidence for improving pain ratings, pain knowledge, disability, pain catastrophization, fear-avoidance, attitudes and behaviors regarding pain, physical movement and healthcare utilization [11]. PNE studies aimed at non-patients (school children and general population), have shown increased knowledge of pain as well as healthier beliefs and attitudes regarding pain, including more interest in pursuing nonpharmacological treatments [3,12]. From a psychological perspective, PNE research has demonstrated positive impacts on pain catastrophization and fear-avoidance, shifting individuals to a positive outlook, optimism and goals, which in turn has been associated with a positive recovery and future outlook [11,13].…”