ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia.
School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia.
Pain. 2022 Jan 1;163(1):e20-e30. doi: 10.1097/j.pain.0000000000002308.
Exercise and pain neuroscience education (PNE) have both been used as standalone treatments for chronic musculoskeletal pain. The evidence supporting PNE as an adjunct to exercise therapy is growing but remains unclear. The aim of this systematic review and meta-analysis was to evaluate the effect of combining PNE and exercise for patients with chronic musculoskeletal pain, when compared with exercise alone. A systematic search of electronic databases was conducted from inception to November 6, 2020. A quality effects model was used to meta-analyze outcomes where possible. Five high-quality randomized controlled studies (n = 460) were included in this review. The PEDro scale was used to assess the quality of individual studies, and Grading of Recommendations, Assessment, Development, and Evaluation analysis was conducted to determine the quality of evidence for each outcome. Meta-analyses were performed for pain intensity, disability, kinesiophobia, and pain catastrophizing using data reported between 0 and 12 weeks postintervention. Long-term outcomes (>12 weeks) were only available for 2 studies and therefore were not suitable for meta-analysis. Meta-analysis revealed a significant difference in pain (weighted mean differences, -2.09/10; 95% confidence interval [CI], -3.38 to -0.80; low certainty), disability (standardized mean difference, -0.68; 95% CI, -1.17 to -0.20; low certainty), kinesiophobia (standardized mean difference, -1.20; CI, -1.84 to -0.57; moderate certainty), and pain catastrophizing (weighted mean differences, -7.72; 95% CI, -12.26 to -3.18; very low certainty) that favoured the combination of PNE and exercise. These findings suggest that combining PNE and exercise in the management of chronic musculoskeletal pain results in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing relative to exercise alone.
运动和疼痛神经科学教育（PNE）都已被用作慢性肌肉骨骼疼痛的独立治疗方法。支持 PNE 作为运动疗法辅助治疗的证据不断增加，但仍不明确。本系统评价和荟萃分析的目的是评估 PNE 与运动相结合治疗慢性肌肉骨骼疼痛患者的效果，与单独运动相比。从研究开始到 2020 年 11 月 6 日，对电子数据库进行了系统搜索。在可能的情况下，使用质量效应模型对结果进行荟萃分析。本综述纳入了 5 项高质量随机对照研究（n=460）。使用 PEDro 量表评估个体研究的质量，并进行推荐分级、评估、制定与评价分析以确定每个结果的证据质量。对干预后 0-12 周报告的疼痛强度、残疾、运动恐惧和疼痛灾难化进行荟萃分析。只有 2 项研究提供了>12 周的长期结果，因此不适合进行荟萃分析。荟萃分析显示疼痛（加权均数差，-2.09/10；95%置信区间[CI]，-3.38 至 -0.80；低确定性）、残疾（标准化均数差，-0.68；95%CI，-1.17 至 -0.20；低确定性）、运动恐惧（标准化均数差，-1.20；CI，-1.84 至 -0.57；中等确定性）和疼痛灾难化（加权均数差，-7.72；95%CI，-12.26 至 -3.18；极低确定性）存在显著差异，支持 PNE 与运动相结合。这些发现表明，在慢性肌肉骨骼疼痛的管理中，PNE 与运动相结合相对于单独运动可在短期内更显著地改善疼痛、残疾、运动恐惧和疼痛灾难化。
