Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kutahya Health Sciences University, Kutahya, Turkey.
Int J Rheum Dis. 2022 Apr;25(4):394-404. doi: 10.1111/1756-185X.14293. Epub 2022 Jan 21.
The aim of this study was to investigate whether adding pain neuroscience education (PNE) to a multimodal approach has additional benefits in patients with fibromyalgia (FM). The methodology of this study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The methods and strategies applied in the study were registered in PROSPERO (CRD42021272246). A systematic search with related search terms in the PubMed, Ebsco (Academic Search Ultimate), Cochrane Library, Physiotherapy Evidence Database (PEDro), Medline (Ebsco), Cinahl (Ebsco), Scopus and Web of Science was conducted up to June 2021. Statistical analysis was performed with Comprehensive Meta-Analysis (CMA) software Version 3 (CMA V3, Biostat Inc) comparing before and after values of mean ± standard deviation (SD) data in both groups. The primary outcome of interest was severity of FM (Fibromyalgia Impact Questionnaire), whereas secondary outcomes were pain intensity (visual analog scale, numeric pain rating scale), catastrophizing (Pain Catastrophizing Scale), depression (Hospital Anxiety and Depression Scale [HADS]) and anxiety (HADS). The initial search strategy based on the range and language yielded 274 relevant studies and 4 of these studies met the final eligibility criteria for this study. A total of 612 patients were enrolled in the included studies. The meta-analysis showed that PNE groups were statistically more effective than the interventions applied in the control groups on severity of FM (standard mean difference [SMD] = -1.051; 95% CI = -1.309, -0.793; P < .000), pain intensity (SMD = -1.049; 95% CI = -1.400, -0.698; P < .000), catastrophizing (SMD = -0.893; 95% CI = -1.437, -0.348; P = .001), depression (SMD = -0.686; 95% CI = -0.849, -0.523; P < .000) and anxiety (SMD = -0.711; 95% CI = -0.869, -0.552; P < .000). This review demonstrates that adding PNE to a multimodal treatment including exercise therapy might be an effective approach for improving functional status, pain-related symptoms, anxiety and depression for patients with FM. There is a need for further studies, especially on the optimum duration and dosage of PNE sessions in FM.
本研究旨在探讨在多模式治疗中加入疼痛神经科学教育（PNE）是否对纤维肌痛（FM）患者有额外的益处。本研究的方法学符合系统评价和荟萃分析的首选报告项目指南。该研究中应用的方法和策略已在 PROSPERO（CRD42021272246）中注册。对 PubMed、Ebsco（学术搜索终极版）、Cochrane 图书馆、物理治疗证据数据库（PEDro）、Medline（Ebsco）、CINHAL（Ebsco）、Scopus 和 Web of Science 中的相关搜索词进行了系统搜索，截至 2021 年 6 月。使用 Comprehensive Meta-Analysis（CMA）软件版本 3（CMA V3，Biostat Inc）对两组的均值±标准差（SD）数据进行了前后比较，进行了统计分析。主要观察指标为 FM 的严重程度（纤维肌痛影响问卷），次要观察指标为疼痛强度（视觉模拟量表、数字疼痛评分量表）、灾难化（疼痛灾难化量表）、抑郁（医院焦虑和抑郁量表[HADS]）和焦虑（HADS）。基于范围和语言的初始搜索策略产生了 274 项相关研究，其中 4 项研究符合本研究的最终纳入标准。共有 612 名患者纳入纳入研究。荟萃分析显示，PNE 组在 FM 严重程度（标准均数差[SMD] =-1.051；95%CI=-1.309，-0.793；P<.000）、疼痛强度（SMD=-1.049；95%CI=-1.400，-0.698；P<.000）、灾难化（SMD=-0.893；95%CI=-1.437，-0.348；P=.001）、抑郁（SMD=-0.686；95%CI=-0.849，-0.523；P<.000）和焦虑（SMD=-0.711；95%CI=-0.869，-0.552；P<.000）方面均比对照组的干预措施更有效。本综述表明，在包括运动疗法在内的多模式治疗中加入 PNE 可能是改善 FM 患者功能状态、疼痛相关症状、焦虑和抑郁的有效方法。需要进一步研究，特别是关于 PNE 疗程在 FM 中的最佳持续时间和剂量。
