Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial
Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionalit...
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| Vydáno v: | JAMA neurology Ročník 75; číslo 7; s. 808 |
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| Hlavní autoři: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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United States
01.07.2018
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| ISSN: | 2168-6157, 2168-6157 |
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| Abstract | Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.
To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.
Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.
Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).
Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).
There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).
Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.
clinicaltrials.gov Identifier: NCT02098005. |
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| AbstractList | Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.ImportanceEffective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.ObjectiveTo compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain.Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.Design, Setting, and ParticipantsMulticenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months.Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).InterventionsParticipants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy).Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).Main Outcomes and MeasuresPrimary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health).There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).ResultsThere were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014).Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.Conclusions and RelevancePain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population.clinicaltrials.gov Identifier: NCT02098005.Trial Registrationclinicaltrials.gov Identifier: NCT02098005. Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. clinicaltrials.gov Identifier: NCT02098005. |
| Author | De Pauw, Robby Cagnie, Barbara Coppieters, Iris Danneels, Lieven Kregel, Jeroen Nijs, Jo Malfliet, Anneleen Meeus, Mira Roussel, Nathalie |
| Author_xml | – sequence: 1 givenname: Anneleen surname: Malfliet fullname: Malfliet, Anneleen organization: Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium – sequence: 2 givenname: Jeroen surname: Kregel fullname: Kregel, Jeroen organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium – sequence: 3 givenname: Iris surname: Coppieters fullname: Coppieters, Iris organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium – sequence: 4 givenname: Robby surname: De Pauw fullname: De Pauw, Robby organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium – sequence: 5 givenname: Mira surname: Meeus fullname: Meeus, Mira organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium – sequence: 6 givenname: Nathalie surname: Roussel fullname: Roussel, Nathalie organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Antwerp, Belgium – sequence: 7 givenname: Barbara surname: Cagnie fullname: Cagnie, Barbara organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium – sequence: 8 givenname: Lieven surname: Danneels fullname: Danneels, Lieven organization: Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium – sequence: 9 givenname: Jo surname: Nijs fullname: Nijs, Jo organization: Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29710099$$D View this record in MEDLINE/PubMed |
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| PublicationPlace | United States |
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| PublicationTitle | JAMA neurology |
| PublicationTitleAlternate | JAMA Neurol |
| PublicationYear | 2018 |
| References | 30667459 - JAMA Neurol. 2019 Mar 1;76(3):372-373 30667457 - JAMA Neurol. 2019 Mar 1;76(3):371-372 30667470 - JAMA Neurol. 2019 Mar 1;76(3):373 |
| References_xml | – reference: 30667457 - JAMA Neurol. 2019 Mar 1;76(3):371-372 – reference: 30667459 - JAMA Neurol. 2019 Mar 1;76(3):372-373 – reference: 30667470 - JAMA Neurol. 2019 Mar 1;76(3):373 |
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| Snippet | Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.
To compare pain neuroscience education... Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs.ImportanceEffective treatments for... |
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| SubjectTerms | Adult Back Pain - diagnostic imaging Back Pain - physiopathology Back Pain - psychology Back Pain - rehabilitation Central Nervous System Sensitization Chronic Pain - diagnostic imaging Chronic Pain - physiopathology Chronic Pain - psychology Chronic Pain - rehabilitation Cognition Exercise Therapy - methods Failed Back Surgery Syndrome - diagnostic imaging Failed Back Surgery Syndrome - physiopathology Failed Back Surgery Syndrome - psychology Failed Back Surgery Syndrome - rehabilitation Female Gray Matter - diagnostic imaging Humans Low Back Pain - diagnostic imaging Low Back Pain - physiopathology Low Back Pain - psychology Low Back Pain - rehabilitation Male Middle Aged Neck Pain - diagnostic imaging Neck Pain - physiopathology Neck Pain - psychology Neck Pain - rehabilitation Neurosciences - education Patient Education as Topic Physical Therapy Modalities Whiplash Injuries - diagnostic imaging Whiplash Injuries - physiopathology Whiplash Injuries - psychology Whiplash Injuries - rehabilitation |
| Title | Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/29710099 https://www.proquest.com/docview/2033383402 |
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