How Much Is Needed? Comparison of the Effectiveness of Different Pain Education Dosages in Patients with Fibromyalgia

Abstract

Objective To assess the effect of different dosages of pain neuroscience education (PNE) programs on central nociceptive processing in patients with fibromyalgia. Second, to compare the effects of different dosages of PNE programs on numerical pain rating scale (NPRS), disability, and psychological variables. Design Single-blind randomized controlled trial. Setting Three fibromyalgia centers in Spain (Valencia, Alcorcón, Alcalá de Henares). Subjects Seventy-seven patients with fibromyalgia. Methods Participants were randomized to four groups of PNE: 1) high-dose PNE (N = 20), 2) low–concentrated dose PNE (N = 20), 3) diluted low-dose PNE (N = 20), and (4) control treatment (N = 17), conducted in two 30–50-minute sessions in groups of four to six participants. Conditioned pain modulation (CPM), temporal summation (TS), and pressure pain thresholds (PPTs) were assessed at baseline and at three-month follow-up. Secondary outcome measures were the Fibromyalgia Impact Questionnaire, Pain Catastrophizing Scale, and Pain Anxiety Symptoms Scale. Results There were significant between-group differences for NPRS in favor of the groups receiving high-dose PNE, with a large effect size at three-month follow-up (P < 0.01, η2p = 0.170), but there were no significant differences between groups for the remaining variables (P > 0.05). All groups improved for central nociceptive processing, psychological variables, disability, and pain intensity (NPRS). Conclusions In patients with fibromyalgia, higher dosages of PNE produced a larger improvement in pain severity at three-month follow-up than other dosages of PNE and biomedical education. However, PNE was not superior to biomedical education in the central nociceptive processing, disability, or psychological variables in patients with fibromyalgia.

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial

“…Reduction in pain intensity, as well as number of body areas with pain, was higher in the EG compared to the CG. This was an expected finding, as there was a significant decrease in pain intensity in persistent pain processes related to CS (fibromyalgia) in previous studies in which high doses of PNE were applied [51]. In subjects with chronic lower back pain, a significant reduction in pain intensity was also observed after application of PNE and PE in combination [46][47][48]105,106].…”

“…In an attempt to adapt the intervention of the EG to PC, we chose to include a series of components in the treatment program considered of crucial importance for the outcomes obtained. The first one was to choose an intense educational intervention similar to that used in previous studies [51], which might have favoured the modification of beliefs about pain [112], and that was continually strengthened throughout the program with the delivery of support material [113][114][115]. The second important aspect was the fact that the intervention of the EG was applied in a group, which favoured socialization [68][69][70] and took many patients out of their social isolation.…”

“…There is a lot of variability in the intensity, content, and way of performing these interventions. Some research has shown that intense PNE interventions are more effective [51]. However, the effectiveness of PNE as an isolated treatment technique is limited [47] and its effects increase when combined with a targeted PE program [52,53].…”

Efficacy of a Multicomponent Intervention for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): Study Protocol of a Randomized Controlled Trial

“…CBT-based treatments have favoured the acceptance of FM, strengthening of self-efficacy, development of coping strategies, and the reduction in depressive moods [16]. Pain neuroscience education (PNE) has been shown to be more effective than biomedical education [17] for FM and it is proving to be a key strategic piece in both the physical and cognitive approach of FM patients [18][19][20].…”

“…CBT-based treatments have favoured the acceptance of FM, strengthening of self-efficacy, development of coping strategies, and the reduction in depressive moods [16]. Pain neuroscience education (PNE) has been shown to be more effective than biomedical education [17] for FM and it is proving to be a key strategic piece in both the physical and cognitive approach of FM patients [18][19][20].The strengths of such treatments, coupled with the identified benefits of exposure to natural contexts for people's mental health, justify the need to explore new interventions for FM patients conducted in nature. Considering the moderate benefits that have been reported for the four therapeutic components mentioned above, it seems necessary to test empirically, for the first time, the synergistic effects of its combination.…”