Effects of pain neuroscience training combined with neuromuscular exercises on pain, functional disability and psychological factors related to chronic low back pain: A study protocol for a single-blind randomized controlled trial

Abstract

Background: Chronic low back pain (CLBP) is considered one of the most common health conditions, significantly increasing the disease burden worldwide. Several interventions have been used to relieve CLBP. Pain Neuroscience Education (PNE) approach is used to help patients better understand their pain from a biological and physiological perspectives. Specialists also provide it to reduce pain and disability in chronic pain patients. Also, neuromuscular exercises (NMS) are targeted exercises to control impairments presented in CLBP. In this study, PNE combined with NMS is being investigated. Objective: This Randomized Control Trial (RCT) aims to investigate whether a program of NMS combined with PNE on pain, functional disability and psychological factors related to CLBP is effective. Methods/ Design: In this single-blind RCT, 42 patients (men and women, aged 30 to 60) diagnosed with CLBP will be randomly assigned to one of the following groups: (1) PNE plus NMS (21 people) and (2) the NMS (21 people). Outcome assessors will be blinded toward group allocation. The primary outcome will be pain intensity. The secondary outcomes will be disability, fear-avoidance beliefs during work and physical activity, self-efficacy, fear of movement, and kinesiophobia. A blinded assessor will assess all outcomes pre- and post-test. The primary and secondary outcomes will be assessed at baseline and post-intervention (8 weeks) and also at 6 months. Discussion: Pain neuroscience education has been recognized as an effective approach to chronic low back pain management. PNE appears to be effective when combined with NME to reduce pain, improve the patient's knowledge of pain, reduce disability and reduce psychosocial factors, increase movement and minimize the use of health care. Therefore, PNE combined with NME is an effective intervention for patients with chronic low back pain. Study registration: The registration reference is IRCT20190427043384N2. Registered on 17 March 2023.