Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Pain Research Group / Pain Center, Department of Anesthesiology and Intensive Care Medicine, University Hospital Odense, Odense, Denmark.
Pain Med. 2021 Apr 20;22(4):891-904. doi: 10.1093/pm/pnaa484.
To estimate the effectiveness and safety of Pain Neurophysiology Education (PNE) on pain, disability, and psychological distress at post-intervention and long-term (closest to twelve months after initiating the intervention) in musculoskeletal pain (MSKP).
Randomized Controlled Trials (RCT) were identified in six engines, reference lists, ClinicalTrials.gov, and by contacting key researches. Risk of bias was assessed using Cochrane Collaboration Risk of Bias Tool 2.0. Meta-analyses, using Restricted Maximum Likelihood Method, were conducted to estimate standardized mean differences (SMD) and overall quality of evidence was evaluated according to GRADE.
In total, 18 RCTs (n = 1,585) were included. There was small to moderate effects of PNE on pain at post-intervention and long-term: SMD = -0.32 (95% confidence interval [CI]: -.58; -.05) and SMD = -0.40 (95% CI: -.78; -.03), respectively. On disability, PNE had a small effect at post-intervention: SMD = -0.17 (95% CI: -.34; -.01) but was insignificant at long-term: SMD = -0.27 (95% CI: -.59; .06). Likewise, there was a small to moderate effect on psychological distress at post-intervention: SMD = -0.36 (95% CI: -.67; -.06) but was insignificant at long-term: SMD = -0.37 (95% CI: -.75; .01). Quality of evidence was low across all outcomes. Additional analyses showed significant effects of PNE, corresponding to moderate effects, on pain and psychological distress at both time points in chronic MSKP.
Overall quality of evidence was low, supporting PNE being safe and having small to moderate effects on pain at both time points, and on disability as well as psychological distress at post-intervention.
评估疼痛神经生理学教育（PNE）对肌肉骨骼疼痛（MSKP）患者疼痛、残疾和心理困扰的干预后即刻和长期（最接近干预开始后 12 个月）疗效和安全性。
在六个引擎、参考文献列表、ClinicalTrials.gov 以及通过联系主要研究人员中确定了随机对照试验（RCT）。使用 Cochrane 协作风险偏倚工具 2.0 评估偏倚风险。使用受限极大似然法进行荟萃分析，以估计标准化均数差（SMD），并根据 GRADE 评估总体证据质量。
共纳入 18 项 RCT（n=1585）。PNE 对干预后即刻和长期的疼痛有小到中度影响：干预后即刻 SMD = -0.32（95%置信区间 [CI]：-0.58；-0.05），长期 SMD = -0.40（95% CI：-0.78；-0.03）。在残疾方面，PNE 在干预后即刻有较小的影响：SMD = -0.17（95% CI：-0.34；-0.01），但在长期时无统计学意义：SMD = -0.27（95% CI：-0.59；0.06）。同样，PNE 对心理困扰也有小到中度的影响，干预后即刻 SMD = -0.36（95% CI：-0.67；-0.06），但在长期时无统计学意义：SMD = -0.37（95% CI：-0.75；0.01）。所有结局的证据质量均较低。进一步分析显示，PNE 在慢性 MSKP 患者的两个时间点对疼痛和心理困扰都有显著效果，对应中度效果。
总体证据质量较低，支持 PNE 在两个时间点上均安全，对疼痛有小到中度的影响，对残疾和心理困扰在干预后即刻也有影响。
