Comparison the Effect of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic

Abstract

Introduction Self-management education is the basis of any intervention for persons with chronic musculoskeletal pain. Given the biopsychosocial nature of chronic musculoskeletal pain, an educational approach based on the biopsychosocial model would seem to be an appropriate educational model for the treatment of these people during coronavirus disease 2019 (COVID-19). The aim of this study was to compare the effect of pain neuroscience education (PNE) and pain biomechanics education, using online and face-to-face sessions on pain and fear of movement, in people with chronic nonspecific neck pain during COVID-19. Methods In this multicenter assessor-blinded randomized controlled trial, 80 patients (both male and female) with chronic nonspecific neck pain (based on the inclusion criteria of the study) participated in educational sessions (face-to-face and online) from the beginning September until the end of October 2021. The participants were randomly divided into two groups (through the selection of numbers from 1 to 80, hidden in a box), with one group receiving PNE (treatment group) and the other group receiving pain biomechanics education (control group). Pain and fear of movement before and after the intervention were measured on the Numerical Pain Rating Scale and the Tampa Scale of Kinesiophobia, respectively. A 2 × 2 variance analysis (treatment group × time) with a mixed-model design was applied to statistically analyze the data. Results No significant change in pain ( P = 0.23) was observed between the two groups ( P = 0.24, Cohen's d = 0.17, 95% confidence interval [CI] − 0.21 to 0.35), while changes in the fear of movement variable were reported to be significant ( P = 0.04, Cohen's d = 0.34, 95% CI 0.11–0.51), in favor of PNE. Intra-group change was seen only in the PNE group for the fear of movement variable ( P = 0.04; 14.28%↓). Conclusion In our study population PNE did not affect the pain index, leading to the conclusion that PNE should not be used as the only treatment, but possibly in combination with other active/passive therapy to enhance the results for patients with nonspecific chronic neck pain. Moreover, online treatment may help clinicians to increase their interaction with patients during COVID-19 lockdown.

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

“…Among the former, one study compared PNE, neck/scapula stabilizer muscle strengthening and usual care (Javdaneh et al, 2021); one study compared PNE, dry needling and usual care (Valiente‐Castrillo et al, 2021) and the other compared standard PNE, culturally sensitive PNE and trunk strengthening exercises (Mukhtar et al, 2022). Among the latter, two studies compared PNE with neck and scapular stabilizer muscle strengthening (Andias et al, 2022; Matias et al, 2019), one with biomechanical education (Khosrokiani et al, 2022) and one with usual care (Andias et al, 2018).…”

“…Regarding pain intensity measurement, two studies used an NRS (Andias et al, 2022;Khosrokiani et al, 2022), four used a VAS (Andias et al, 2018;Matias et al, 2019;Mukhtar et al, 2022;Valiente-Castrillo et al, 2021), and one used an NPAD (Javdaneh et al, 2021) as the outcome measurement for pain intensity. In terms of kinesiophobia, four of seven RCTs used the TSK as the outcome measurement for kinesiophobia (Andias et al, 2022;Khosrokiani et al, 2022;Matias et al, 2019;Valiente-Castrillo et al, 2021). Additionally, three studies used the group class method for all the PNE sessions (Andias et al, 2018(Andias et al, , 2022Matias et al, 2019).…”

The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: A systematic review and dose–response meta-analysis

“…2,23,24,31,34,35,56,62,67,71,73 In the remaining 15 studies, 3,5,6,20,30,32,37,41,48,49,52,61,66,74,77 follow-up ranged from 3 to 12 months. Pain intensity was assessed using the visual analogue scale (VAS) in 10 studies, 2,20,23,24,32,41,52,61,62,74 the Numerical Pain Scale (NPRS) in 11, 3,5,6,30,34,35,48,66,67,71,77 the Neck Pain and Disability Scale (NPDS) in one, 31 and PROMIS in one. 37 Disability was assessed using the RMDQ in 11 studies, 5,…”

“…Finally, a total of 26 studies were included in the systematic review. 2,3,5,6,20,23,24,[30][31][32]34,35,37,41,48,49,52,56,61,62,66,67,71,73,74,77…”

“…7 However, in the past years, new evidence seems to support the effectiveness of PNE in this population. 3,5,23,24,[30][31][32]34,35,37 However, to the best of authors' knowledge, no systematic review has still determined the optimal dose of PNE added to an exercise programme required for achieving clinically relevant improvements in terms of pain intensity and disability in patients with CSP. This information could be useful to guide clinicians' decision-making when using PNE to treat patients with CSP.…”