Malfliet Anneleen, Lenoir Dorine, Murillo Carlos, Huysmans Eva, Cagnie Barbara, Meeus Mira, Willaert Ward, Ickmans Kelly, Danneels Lieven, Bontinck Jente, Nijs Jo, Coppieters Iris
Pain in Motion Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.
Research Foundation-Flanders, Brussels, Belgium.
JAMA Netw Open. 2025 Aug 1;8(8):e2526674. doi: 10.1001/jamanetworkopen.2025.26674.
Chronic whiplash-associated disorders (cWAD) pose significant personal and societal burden, with limited evidence-based management options.
To compare the efficacy of the modern pain neuroscience approach (MPNA) with usual care physiotherapy (UC) in cWAD.
DESIGN, SETTING, AND PARTICIPANTS: This multicenter randomized clinical trial with long-term follow-up was organized at 2 university hospitals and 1 regional hospital in Belgium. Participants included patients with cWAD aged 18 to 65 years. Data collection occurred between August 2017 and July 2022. Final analyses were performed from June to August 2024.
Participants were randomized into MPNA or UC and received 18 sessions during 16 weeks. MPNA included pain neuroscience education, stress management, and cognition-targeted, time-contingent exercise therapy. UC included biomedically focused education and symptom-contingent exercise therapy.
The primary end point was pain-related disability (ie, Neck Disability Index) at the 6-month follow-up. Exploratory secondary outcomes included pain, pain cognitions, quality of life, physical functioning, and cost utility, with assessments until 12 months after the intervention.
A total of 120 participants (mean [SD] age, 41.4 [11.3] years; 89 [74.2%] women) were included. Mean neck pain-related disability decreased by 5.74 points (33.3%) in the MPNA group and 3.22 points (15.8%) in the UC group. There was no significant difference at 6 months (mean group difference [MGD], 2.38 [95% CI, -0.12 to 4.89] points; P = .15; Cohen d = 0.646), but significant differences favored MPNA immediately after treatment (MGD, 3.55 [95% CI, 1.12-6.26] points; P = .006; Cohen d = 0.999) and at 12-month follow-up (MGD, 3.54 [95% CI, 0.81-6.28] points; P = .02; Cohen d = 0.947). On an explorative basis, MPNA consistently outperformed UC in improving fear-avoidance behavior (Cohen d range, 0.906-1.112) and self-reported central sensitization symptoms (Cohen d range, 1.158-1.834) and was cost-effective, saving US $854.01 with an increase of 0.035 quality-adjusted life-years. No group differences were found for quality of life, (experimental) pain, and pain catastrophizing. However, 14 (23.3%) of the MPNA group was free of pain (ie, 0 or 1 of 10 in pain intensity score) directly after treatment vs only 3 (5.0%) in the UC group.
In this randomized clinical trial, no significant differences were observed between groups for the primary outcome at 6 months. MPNA was more effective than UC in reducing neck pain-related disability immediately after treatment and at 12-month follow-up, with additional benefits in pain-related anxiety, self-reported central sensitization symptoms, and cost-effectiveness. Overall, MPNA shows promise for managing cWAD.
ClinicalTrials.gov Identifier: NCT03239938.
慢性挥鞭样损伤相关疾病（cWAD）给个人和社会带来了沉重负担，而基于证据的管理方案有限。
比较现代疼痛神经科学方法（MPNA）与常规护理物理治疗（UC）对cWAD的疗效。
设计、设置和参与者：这项具有长期随访的多中心随机临床试验在比利时的2所大学医院和1所地区医院进行。参与者包括18至65岁的cWAD患者。数据收集于2017年8月至2022年7月期间进行。最终分析于2024年6月至8月进行。
参与者被随机分为MPNA组或UC组，并在16周内接受18次治疗。MPNA包括疼痛神经科学教育、压力管理以及针对认知的、有时间限制的运动疗法。UC包括以生物医学为重点的教育和针对症状的运动疗法。
主要终点是6个月随访时与疼痛相关的残疾（即颈部残疾指数）。探索性次要结局包括疼痛、疼痛认知、生活质量、身体功能和成本效益，干预后12个月内进行评估。
共纳入120名参与者（平均[标准差]年龄，41.4[11.3]岁；89名[74.2%]为女性）。MPNA组的颈部疼痛相关残疾平均降低了5.74分（33.3%），UC组降低了3.22分（15.8%）。6个月时无显著差异（组间平均差异[MGD]，2.38[95%置信区间，-0.12至4.89]分；P = 0.15；Cohen d = 0.646），但治疗后立即显示MPNA有显著差异（MGD，3.55[95%置信区间，1.12 - 6.26]分；P = 0.006；Cohen d = 0.999），12个月随访时也有显著差异（MGD，3.54[95%置信区间，0.81 - 6.28]分；P = 0.02；Cohen d = 0.947）。在探索性基础上，MPNA在改善恐惧回避行为（Cohen d范围，0.906 - 1.112）和自我报告的中枢敏化症状（Cohen d范围，1.158 - 1.834）方面始终优于UC，且具有成本效益，节省了854.01美元，质量调整生命年增加了0.035。在生活质量、（实验性）疼痛和疼痛灾难化方面未发现组间差异。然而，MPNA组中有14名（23.3%）在治疗后立即无疼痛（即疼痛强度评分为10分中的0或1分），而UC组中只有3名（5.0%）。
在这项随机临床试验中，6个月时两组在主要结局上未观察到显著差异。MPNA在治疗后立即和12个月随访时比UC更有效地降低了颈部疼痛相关残疾，在疼痛相关焦虑、自我报告的中枢敏化症状和成本效益方面还有额外益处。总体而言，MPNA在管理cWAD方面显示出前景。
ClinicalTrials.gov标识符：NCT03239938。
