Lane Elizabeth, Fritz Julie M, Greene Tom, Maddox Daniel
Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA.
BMC Musculoskelet Disord. 2018 Oct 25;19(1):386. doi: 10.1186/s12891-018-2269-2.
Chronic spinal pain affects many in the United States and is associated with rising healthcare costs - but not improved outcomes. Education and self-care promotion are hallmarks of the recommended approach for this condition. Pain Neuroscience Education (PNE) is a method of educating patients about the neurophysiology of pain that aims to reconceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system. PNE has shown efficacy in controlled situations when delivered by experts, but its effectiveness has not been investigated among trained clinicians in a pragmatic setting.
A cluster randomized trial will randomly assign 16 clinic regions to either receive PNE training or continue with usual care. Patients with chronic neck or back pain will be enrolled to provide outcome data. Measures will be collected at baseline, 2 weeks, and 12 weeks. The primary outcome will be the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer-adapted test (PF-CAT). Pre-specified statistical analyses will compare outcomes between clinic regions assigned to PNE treatment or usual care while using random effects to account for region-level clustering.
Pain Neuroscience Education has been shown efficacious for a variety of patient-centered outcomes for those with chronic pain, but it has not yet been investigated outside of controlled settings. This trial has the potential to promote PNE as a low-cost intervention for chronic spinal pain and affect physical therapy education.
ClinicalTrials.gov identifier NCT03168165 , registered May 30, 2017.
慢性脊柱疼痛在美国影响着许多人，并与医疗成本上升相关，但并未带来更好的治疗效果。教育和自我护理推广是针对这种情况推荐方法的标志。疼痛神经科学教育（PNE）是一种向患者传授疼痛神经生理学的方法，旨在将疼痛从损伤指标重新概念化为大脑和神经系统对输入信号的一种解读。在由专家进行授课的对照情况下，PNE已显示出疗效，但尚未在实际环境中对经过培训的临床医生的有效性进行研究。
一项整群随机试验将随机分配16个诊所区域，使其要么接受PNE培训，要么继续常规护理。患有慢性颈部或背部疼痛的患者将被纳入以提供结果数据。将在基线、2周和12周时收集测量数据。主要结局将是患者报告结局测量信息系统（PROMIS）身体功能计算机自适应测试（PF-CAT）。预先指定的统计分析将比较分配接受PNE治疗或常规护理的诊所区域之间的结局，同时使用随机效应来考虑区域层面的聚类。
疼痛神经科学教育已被证明对慢性疼痛患者的各种以患者为中心的结局有效，但尚未在对照环境之外进行研究。该试验有可能推广PNE作为一种针对慢性脊柱疼痛的低成本干预措施，并影响物理治疗教育。
ClinicalTrials.gov标识符NCT03168165，于2017年5月30日注册。
