Soft-Tissue Mobilization and Pain Neuroscience Education for Chronic Nonspecific Low Back Pain with Central Sensitization: A Prospective Randomized Single-Blind Controlled Trial

Abstract

This study was conducted to demonstrate the therapeutic effect of soft-tissue mobilization (STM) combined with pain neuroscience education (PNE) for patients with chronic nonspecific low back pain with central sensitization. A total of 28 participants were recruited and randomly allocated to either the STM group (SMG) (n = 14) or the STM plus PNE group (BG; blended group) (n = 14). STM was applied twice a week for four weeks, with a total of eight sessions, and PNE was applied within four weeks, for a total of two sessions. The primary outcome was pain intensity, and the secondary outcomes were central sensitization, pressure pain, pain cognition, and disability. Measurements were made at baseline, after the test, and at 2-week and 4-week follow-ups. The BG showed significant improvement in pain intensity (p < 0.001), pressure pain (p < 0.001), disability (p < 0.001), and pain cognition (p < 0.001) compared to the SMG. This study demonstrated that STM plus PNE is more effective for all measured outcomes compared to STM alone. This finding suggests that the combination of PNE and manual therapy has a positive effect on pain, disability index, and psychological factors in the short term.

Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study

“…The researchers attributed this effect to the Fear Avoidance Model applied as PNE [50], which effectively reduced levels of kinesiophobia by explaining anxiety, fear, avoidance due to fear, and their consequences for pain experience. Our research results also align with the findings of Song et al [13], who identified a significant reduction in the TSK and PCS scores by adding PNE to a four-week manual therapy program for patients with CNLBP. However, it is worth noting that the improvements identified in our study were greater for both scores (TSK and PCS) compared to this research.…”

“…The objective of this clinical study was to examine the effectiveness of a manual therapy protocol in conjunction with the provision of PNE with integrated MI. Compared to other studies that similarly applied combined manual therapy and PNE protocols in individuals with CNLBP [12,13,42,43], the innovation of our study was the integration of the MI component in PNE. We hypothesized that the addition of MI to PNE in a manual therapy program could increase the positive effects and provide more long-term results related to the application of manual therapy alone.…”

“…In contrast to manual therapy, where the physiotherapist solely focuses on tissue pathology, PNE aims to reconceptualize pain by teaching patients more about the neurobiological and neurophysiological processes involved in their pain experiences [9]. However, recent evidence suggests that adding PNE to a manual therapy intervention further increases the hypoalgesic effect and improves short-term outcomes related to kinesiophobia and catastrophizing [12,13]. Some authors suggest that these benefits are likely due to enhancing patient expectations while contributing to the refreshing or sharpening of body schema maps within the brain [9].…”

Immediate or Short-term Effects of Thrust Manipulation on Acute to Subacute Low Back Pain: A Systematic Review and Meta-Analysis

“…Another perspective to consider is the psychological aspect of pain and disability. It's established in literature that pain cognition is multi-dimensional, encompassing not only the physical but also emotional, cognitive, social factors [34,35]. Thus, even if thrust manipulation managed to address the nociceptive component of pain effectively, it may not have dealt with other underlying issues, like fear of movement or re-injury, that contribute to disability [36][37][38].…”