Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis

Abstract

Exercise and pain neuroscience education (PNE) have both been used as standalone treatments for chronic musculoskeletal pain. The evidence supporting PNE as an adjunct to exercise therapy is growing but remains unclear. The aim of this systematic review and metaanalysis was to evaluate the effect of combining PNE and exercise for patients with chronic musculoskeletal pain, when compared with exercise alone. A systematic search of electronic databases was conducted from inception to November 6, 2020. A quality effects model was used to meta-analyze outcomes where possible. Five high-quality randomized controlled studies (n 5 460) were included in this review. The PEDro scale was used to assess the quality of individual studies, and Grading of Recommendations, Assessment, Development, and Evaluation analysis was conducted to determine the quality of evidence for each outcome. Meta-analyses were performed for pain intensity, disability, kinesiophobia, and pain catastrophizing using data reported between 0 and 12 weeks postintervention. Long-term outcomes (.12 weeks) were only available for 2 studies and therefore were not suitable for meta-analysis. Meta-analysis revealed a significant difference in pain (weighted mean differences, 22.09/10; 95% confidence interval [CI], 23.38 to 20.80; low certainty), disability (standardized mean difference, 20.68; 95% CI, 21.17 to 20.20; low certainty), kinesiophobia (standardized mean difference, 21.20; CI, 21.84 to 20.57; moderate certainty), and pain catastrophizing (weighted mean differences, 27.72; 95% CI, 212.26 to 23.18; very low certainty) that favoured the combination of PNE and exercise. These findings suggest that combining PNE and exercise in the management of chronic musculoskeletal pain results in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing relative to exercise alone.

Effects of Pain Neuroscience Education Combined with Lumbar Stabilization Exercise on Strength and Pain in Patients with Chronic Low Back Pain: Randomized Controlled Trial

“…Although several studies have shown that the changes and improvements in functional and symptomatic outcomes with physical therapy and the application of PNE are effective in reducing pain and improving dysfunction [24,25], high-quality studies on PNE and exercise combinations for chronic low back pain are still needed because of the diversity of interventional exercise types, PNE application methods, and participants in previous studies [26,27].…”

Older Adult Use and Outcomes in a Digital Musculoskeletal (MSK) Program, by Generation

“…Reviews have concluded that exercise therapy vs. usual care offered pain reduction, reduced depression severity, and improved quality of life (11,12). Pain neuroscience education can further enhance these benefits (13).…”

Efficacy of the FIBROWALK Multicomponent Program Moved to a Virtual Setting for Patients with Fibromyalgia during the COVID-19 Pandemic: A Proof-of-Concept RCT Performed Alongside the State of Alarm in Spain

“…In this regard, PNE is aimed at educating patients on the mechanisms behind chronic pain, highlighting that any credible evidence of danger or safety in body tissues can increase or decrease pain perception, respectively [22], and has been found to be effective in patients with FM [18][19][20][21][22][23][24][25][26][27][28]. It is noteworthy that PNE seems even more effective when it is combined with therapeutic exercise, gradual exposure techniques, and CBT [24,70], all of which are integrated elements in the FIBROWALK program. On the other hand, mindfulness training is aimed at modifying the relationship with one's thoughts-to be more nonjudgmentally open to them, with acceptance-rather than at changing their content [71].…”