Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain.
Uncertainty, Mindfulness, Self, Spirituality (UMSS) Research Group, Universidad de Sevilla, Sevilla, Spain.
J Orthop Sports Phys Ther. 2023 Jun;53(6):353–368. doi: 10.2519/jospt.2023.11833.
We aimed to summarize the evidence of the effects of pain neuroscience education delivered alone or combined with other interventions for chronic pain. An overview of systematic reviews with meta-analysis. CINAHL (via EBSCOhost), Embase, PsycINFO (via ProQuest), PubMed, and the Cochrane Library were searched from their inception to November 14, 2022. Systematic reviews (SRs) with meta-analyses including randomized clinical trials. The outcomes were pain and psychological symptoms. AMSTAR 2 assessed the methodological quality of SRs. The primary study overlap was evaluated by calculating the corrected covered area (CCA). We included 8 SRs including 30 meta-analyses of interest that comprised 28 distinct clinical trials. In some meta-analyses, pain neuroscience education delivered alone or combined with other interventions was more effective than control interventions for reducing pain intensity, pain catastrophizing, kinesiophobia, anxiety symptoms, and depression symptoms at some time points. However, other meta-analyses found a lack of effects of pain neuroscience education, and there were inconsistencies between meta-analyses covering the same outcome. The methodological quality of all SRs was critically low. The overlap, including all SRs, was high (CCA = 13%), and very high for SRs covering trials on chronic low back pain (CCA = 40%), chronic spine pain (CCA = 27%), and fibromyalgia (CCA = 25%). It is impossible to make clear clinical recommendations for delivering pain neuroscience education based on current meta-analyses. Action is needed to increase and improve the quality of SRs in the field of pain neuroscience education. .
我们旨在总结单独或结合其他干预措施治疗慢性疼痛的疼痛神经科学教育效果的证据。这是一个系统综述的概述，其中包括荟萃分析。从创建之初到 2022 年 11 月 14 日，我们在 CINAHL（通过 EBSCOhost）、Embase、PsycINFO（通过 ProQuest）、PubMed 和 Cochrane Library 上进行了系统检索。包括随机临床试验的系统综述（SRs）和荟萃分析。结局是疼痛和心理症状。AMSTAR 2 评估了 SR 的方法学质量。通过计算校正覆盖面积（CCA）来评估主要研究重叠情况。我们纳入了 8 项系统综述，其中包括 30 项有意义的荟萃分析，涵盖了 28 项不同的临床试验。在一些荟萃分析中，与对照组相比，单独或结合其他干预措施的疼痛神经科学教育在某些时间点更能有效减轻疼痛强度、疼痛灾难化、运动恐惧、焦虑症状和抑郁症状。然而，其他荟萃分析发现疼痛神经科学教育没有效果，并且涵盖相同结局的荟萃分析之间存在不一致。所有 SR 的方法学质量都非常低。所有 SR 的重叠度（CCA = 13%），以及涵盖慢性腰痛（CCA = 40%）、慢性脊柱疼痛（CCA = 27%）和纤维肌痛（CCA = 25%）试验的 SR 的重叠度非常高（CCA = 25%）。基于目前的荟萃分析，无法为提供疼痛神经科学教育提供明确的临床建议。需要采取行动来增加和提高疼痛神经科学教育领域的 SR 质量。
