Tatikola Sripada Pallavi, Natarajan Venkatesh, Amaravadi Sampath Kumar, Desai Venkata Krishnaveni, Asirvatham Adlyne Reena, Nagaraja Ravishankar
Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu State, India; Apollo College of Physiotherapy, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana State, India.
Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu State, India.
J Bodyw Mov Ther. 2025 Mar;41:215-237. doi: 10.1016/j.jbmt.2024.11.016. Epub 2024 Nov 17.
Chronic pain poses a multifaceted and prevalent challenge that significantly affects an individual's quality of life. Sensory mechanisms, behavioural components (kinesiophobia and catastrophising), and social factors can influence pain perception in both younger and older populations. Moreover, the mechanisms underlying these altered pain phenotypes require further investigation in order to plan appropriate treatment. While Pain Neuroscience Education (PNE) has proven effective in managing chronic pain and previous research has been conducted on PNE physiotherapeutic techniques, there remains insufficient evidence on the efficacy of these adjunctive treatments.
The objective of the present systematic review and meta-analysis was to evaluate the evidence for the efficacy of PNE + PT (PNE) on pain as a primary outcome and 12 other psychosocial variables as secondary outcomes in patients with different pain mechanisms, and whether PNE could be applied to painful diabetic neuropathy.
A thorough literature search was conducted in the database Scopus, MEDLINE/PubMed, ScienceDirect, CINAHL, and Web of Science, using keywords like "Pain Neuroscience Education", and "Chronic Pain" from 2010 to 2024 based on inclusion and exclusion criteria. Twenty of the 2558 studies that underwent screening qualified for a meta-analysis and 24 of them for a systematic review. Cochrane Risk of Bias 2 was used to assess the quality of the studies. Forest plots were generated using the Revman 5.3 software.
Studies that predominantly addressed central sensitization and neuropathic pain demonstrated moderate-to good-quality evidence. The review findings indicate that PNE is effective in reducing experienced pain intensity and experienced pain interference on the Visual Analogue Scale (VAS: SMD -0.70, 95% CI -1.26 to -0.14), Numerical Pain Rating Scale (NPRS SMD -1.71, 95% CI -2.34 to -1.08), reduced kinesiophobia (Tampa scale of Kinesiophobia: SMD -5.29, 95% CI -7.33 to -3.25), and catastrophizing (pain catastrophizing scale: -3.82, 95% CI -6.44 to -1.21).
PNE has been found to be an effective intervention for reducing perceived pain experience, pain interference and other psychosocial variables in the management of chronic pain with different pain mechanisms. Most studies have focused on central sensitization, urging future research to explore PNE efficacy in neuropathic pain, such as painful diabetic neuropathy.
CRD42023451101.
慢性疼痛是一个多方面且普遍存在的挑战，严重影响个人生活质量。感觉机制、行为因素（运动恐惧和灾难化思维）以及社会因素会影响年轻人和老年人的疼痛感知。此外，这些改变的疼痛表型背后的机制需要进一步研究，以便制定合适的治疗方案。虽然疼痛神经科学教育（PNE）已被证明在管理慢性疼痛方面有效，并且之前已经对PNE物理治疗技术进行了研究，但这些辅助治疗的疗效证据仍然不足。
本系统评价和荟萃分析的目的是评估PNE + PT（PNE）对不同疼痛机制患者以疼痛为主要结局以及另外12个心理社会变量为次要结局的疗效证据，以及PNE是否可应用于疼痛性糖尿病神经病变。
根据纳入和排除标准，在Scopus、MEDLINE/PubMed、ScienceDirect、CINAHL和Web of Science数据库中进行了全面的文献检索，使用了“疼痛神经科学教育”和“慢性疼痛”等关键词，检索时间为2010年至2024年。在2558项接受筛选的研究中，有20项符合荟萃分析的条件，24项符合系统评价的条件。使用Cochrane偏倚风险2评估研究质量。使用Revman 5.3软件生成森林图。
主要涉及中枢敏化和神经性疼痛的研究显示出中等至高质量的证据。综述结果表明，PNE在降低视觉模拟量表（VAS：标准化均值差 -0.70，95%置信区间 -1.26至 -0.14）、数字疼痛评分量表（NPRS标准化均值差 -1.71，95%置信区间 -2.34至 -1.08）上的疼痛强度和疼痛干扰、减轻运动恐惧（坦帕运动恐惧量表：标准化均值差 -5.29，95%置信区间 -7.33至 -3.25）以及灾难化思维（疼痛灾难化量表：-3.82，95%置信区间 -6.44至 -1.21）方面有效。
已发现PNE是一种有效的干预措施，可减少不同疼痛机制的慢性疼痛管理中感知到的疼痛体验、疼痛干扰和其他心理社会变量。大多数研究集中在中枢敏化方面，促使未来的研究探索PNE在神经性疼痛（如疼痛性糖尿病神经病变）中的疗效。
PROSPERO注册号：CRD42023451101。
