Louw Adriaan
International Spine and Pain Institute , Story City, IA , USA.
Physiother Theory Pract. 2014 Nov;30(8):588-96. doi: 10.3109/09593985.2014.912255. Epub 2014 Apr 29.
Therapeutic neuroscience education (TNE) aims to alter a patient's thoughts and beliefs about pain and has shown efficacy in treating chronic pain. To date, TNE sessions mainly consist of one-on-one verbal communication. This approach limits availability of TNE to pain patients in remote areas. A 32-year-old patient with chronic low back pain (CLBP) who underwent surgery for thoracic outlet syndrome (TOS) attended a single clinic one-on-one TNE session followed by TNE via electronic mail (e-mail), pacing and graded exposure over a 4-month period. A physical examination, Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), the Disabilities of Arm, Shoulder and Hand (DASH), and Fear-Avoidance Beliefs Questionnaire (FABQ) were assessed during her initial physical therapy visit as well as 1 and 4 months later. Pre-TNE, the patient reported: NPRS (arm) = 7/10; NPRS (leg) = 4/10; ODI = 10.0%; DASH = 36.7%; FABQ-W = 24; and FABQ-PA = 17. After 5 e-mail sessions all outcome measures improved, most noticeably NRS (arm) = 2/10; NRS (leg) = 0/10; DASH = 16.7%; FABQ-W = 8; and FABQ-PA = 7. TNE can potentially be delivered to suffering pain patients in remote areas or to individuals who have time and financial constraints, and likely at a significant reduced cost via e-mail.
治疗性神经科学教育（TNE）旨在改变患者对疼痛的想法和信念，并已在治疗慢性疼痛方面显示出疗效。迄今为止，TNE课程主要由一对一的口头交流组成。这种方法限制了偏远地区疼痛患者获得TNE的机会。一名32岁的慢性下背痛（CLBP）患者因胸廓出口综合征（TOS）接受了手术，参加了一次一对一的门诊TNE课程，随后在4个月的时间里通过电子邮件（e-mail）、逐步调整和分级暴露进行TNE。在她最初的物理治疗就诊时以及1个月和4个月后，对体格检查、数字评分量表（NRS）、Oswestry功能障碍指数（ODI）、手臂、肩部和手部功能障碍（DASH）以及恐惧回避信念问卷（FABQ）进行了评估。在进行TNE之前，患者报告：NPRS（手臂）=7/10；NPRS（腿部）=4/10；ODI=10.0%；DASH=36.7%；FABQ-W=24；FABQ-PA=17。经过5次电子邮件课程后，所有结果指标均有所改善，最明显的是NRS（手臂）=2/10；NRS（腿部）=0/10；DASH=16.7%；FABQ-W=8；FABQ-PA=7。TNE有可能通过电子邮件以显著降低的成本提供给偏远地区的疼痛患者或有时间和经济限制的个人。
