Department of Pathology and Surgery, Center for Translational Research in Physiotherapy, Miguel Hernández University, San Juan de Alicante, Alicante, Spain.
Rehabilitation Service, University Hospital of San Juan de Alicante, San Juan de Alicante, Alicante, Spain.
Eur J Pain. 2024 Nov;28(10):1841-1854. doi: 10.1002/ejp.4700. Epub 2024 Jul 17.
Biopsychosocial approach in patients suffering chronic low back pain (CLBP) promotes pain self-management strategies. Current evidence recommends high dose of Pain Neuroscience Education (PNE) for clinically significant differences. However, the workload and time constraints experienced by healthcare providers impede the application of the recommended treatment regimen. In fact, Back School with a biomechanical model is the main approach to manage CLBP in public systems.
The objective of this study is to explore the effect of a 60 min single session of PNE as an adjunct to back school on pain intensity and psychological variables patients with CLBP.
A double-blind, two-arm randomized controlled clinical trial was conducted in patients with CLBP who attended back school sessions held in a Spanish public hospital. A total of 121 patients were randomized into control group, who received the Back School program during 5 weeks, and intervention group, who additionally received a single session of PNE. Patient-reported outcomes were the Numerical Pain Rating Scale, Central Sensitization Inventory, Pain Catastrophizing Scale, and Tampa Scale of Kinesiophobia, with a 12-week follow-up.
A total of 113 patients were analysed. Intervention and control group presented similar effects on pain and kinesiophobia. At follow-up, intervention group exhibited reduced sensitization and catastrophism scores compared with control, including the subscales. Additionally, PNE reduced the percentage of participants classified as having central sensitization compared with control.
Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophizing at medium-term. This study highlights the potential of PNE to optimize treatment strategies for CLBP, especially in public health centres where time resources are scarce.
Adding a single PNE session in the back school program did not reduce pain but improved psychological factors as central sensitization and pain catastrophism at medium-term.
对患有慢性下腰痛（CLBP）的患者采用生物心理社会方法可促进疼痛自我管理策略。目前的证据建议使用高剂量的疼痛神经科学教育（PNE）以产生显著的临床差异。然而，医疗保健提供者所面临的工作量和时间限制阻碍了推荐治疗方案的实施。事实上，生物力学模型的腰背康复学校是公共系统管理 CLBP 的主要方法。
本研究旨在探讨腰背康复学校课程中增加 60 分钟单次 PNE 对慢性下腰痛患者疼痛强度和心理变量的影响。
在一家西班牙公立医院进行了一项双盲、双臂随机对照临床试验，纳入了参加腰背康复学校课程的慢性下腰痛患者。共 121 名患者随机分为对照组和干预组，对照组在 5 周内接受腰背康复学校课程，干预组在此基础上额外接受一次 PNE 课程。患者报告的结果是数字疼痛评分量表、中枢敏化量表、疼痛灾难化量表和运动恐惧量表，随访时间为 12 周。
共分析了 113 名患者。干预组和对照组在疼痛和运动恐惧方面的效果相似。在随访时，与对照组相比，干预组的敏化和灾难化评分降低，包括各亚量表。此外，与对照组相比，PNE 降低了被归类为存在中枢敏化的参与者的百分比。
在腰背康复学校课程中增加单次 PNE 课程并不能减轻疼痛，但可以在中期改善心理因素，如中枢敏化和疼痛灾难化。本研究强调了 PNE 优化慢性下腰痛治疗策略的潜力，尤其是在时间资源有限的公共卫生中心。
在腰背康复学校课程中增加单次 PNE 课程并不能减轻疼痛，但可以在中期改善心理因素，如中枢敏化和疼痛灾难化。
