Lane Elizabeth, Magel John S, Thackeray Anne, Greene Tom, Fino Nora F, Puentedura Emilio J, Louw Adriaan, Maddox Daniel, Fritz Julie M
Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States.
Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, United States.
Pain. 2022 May 1;163(5):852-860. doi: 10.1097/j.pain.0000000000002436.
Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.
慢性脊柱疼痛给全球医疗保健带来了复杂挑战，亟需有效的干预措施。疼痛神经科学教育（PNE）是一种很有前景的干预方法，其假设是通过改变个体对疼痛的信念、认知和期望来改善疼痛和功能障碍。在严格控制的情况下实施时，疼痛神经科学教育在小型对照试验中已显示出前景。通过更务实的方法探索有前景的干预措施是改善常规临床护理结果的关键但尚未充分研究的一步。目的是研究务实的PNE培训对慢性脊柱疼痛患者临床结果的影响。这项整群随机临床试验在45个门诊物理治疗师（PT）诊所进行。参与者包括108名物理治疗师（45个诊所和16个群组）和319名患者。PT诊所群组被随机分配接受PNE培训或不接受干预，继续常规护理（UC）。我们发现，在12周时，两组在主要结局方面没有显著差异，患者报告结局测量信息系统身体功能计算机自适应测试{平均差异 = 1.05（95%置信区间[CI]：-0.73至2.83），P = 0.25}。与未干预相比，PNE组在12周和2周时疼痛自我效能有显著更大改善（平均差异 = 3.65[95%CI：0.00 - 7.29]，P = 0.049；以及 = 3.08[95%CI：0.07至 - 6.09]，P = 0.045）。然而，在2周时，对照组（41.1%）和治疗组（44.4%）中回答关于治疗是否符合要求问题（疼痛是否被视为一种感知到的威胁）的参与者比例相似。务实的PT PNE培训和实施未能在慢性脊柱疼痛患者中产生显著的功能变化，但与UC PT相比，确实在疼痛自我效能方面产生了显著改善。
