Document Type : Original Articles
Authors
- Fateme Derisfard 1
- Farzane Soleimani 2, 3
- Maryam saadat 2, 3
- Marzieh Saeidi 4
- Hosein Kouhzad Mohamadi 2, 3
1 Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Physiotherapy, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Department of Physiotherapy, School of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract
Background: Chronic non-specific neck pain (CNP) is the second most common musculoskeletal disorder. Central sensitization (CS) of pain is likely a contributing factor to the persistence or recurrence of pain cycles in CNP patients. This study aimed to evaluate the effects of pain neuroscience education (PNE) in addition to conventional physical therapy on pain intensity, CS, and quality of life in patients with CNP who have CS.
Methods: In this quasi-experimental study, 25 patients with CNP and CS participated in a 4-week intervention program that included conventional physical therapy plus PNE. CS, pain intensity, and quality of life were assessed using the CS inventory, visual analog scale (VAS), and SF-36. All participants were evaluated before and after 12 intervention sessions (three times a week).
Results: The results showed that after the intervention, both pain intensity and CS decreased significantly (pain intensity: mean difference = -58.96 ± 16.35, effect size = -3.61; CS: mean difference = -25.52 ± 7.25, effect size = -3.52). Additionally, the quality-of-life score significantly increased (mean difference = 24.04 ± 12.50, effect size = 1.92). A significant correlation was also found between quality-of-life scores and age.
Conclusion: Adding PNE to conventional physical therapy appears to be more effective than conventional physical therapy alone in improving CS, pain intensity, and quality of life in patients with CNP.
Keywords
consequences and risk groups, the DMC3-study. Pain. 2003;102(1):167-78.
2. Roldán-Jiménez C, Pérez-Cruzado D, Neblett R, Gatchel R, Cuesta-Vargas A. Central
sensitization in chronic musculoskeletal pain disorders in different populations: A cross-
sectional study. Pain Med. 2020;21(11):2958-63.
3. Nijs J, Van Houdenhove B, Oostendorp RAB. Recognition of central sensitization in
patients with musculoskeletal pain: Application of pain neurophysiology in manual therapy
practice. Man Ther. 2010;15(2):135-41.
4. C.P. van Wilgen, Keizer D. The Sensitization Model to Explain How Chronic Pain
Exists Without Tissue Damage. Pain Manag Nurs. 2012;13(1):60-5.
5. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on
pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil.
2011;92(12):2041-56.
6. Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain Physiology
Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared
With Pacing and Self-Management Education: A Double-Blind Randomized Controlled
Trial. Arch Phys Med Rehabil. 2010;91(8):1153-9.
7. Matias BA, Vieira I, Pereira A, Duarte M, Silva AG. Pain neuroscience education
plus exercise compared with exercise in university students with chronic idiopathic neck
pain. Int J Ther Rehabil. 2019;26(7):1-14.
8. Linton SJ, van Tulder MW. Preventive interventions for back and neck pain
problems: what is the evidence? Spine. 2001;26(7):778-87.
of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic
pain. Clin J Pain. 2013;29(1):20-5.
10. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience
education on musculoskeletal pain: a systematic review of the literature. Physiother Theory
Pract. 2016;32(5):332-55.
11. Malfliet A, Kregel J, Coppieters I, De Pauw R, Meeus M, Roussel N, et al. Effect of
pain neuroscience education combined with cognition-targeted motor control training on
chronic spinal pain: a randomized clinical trial. JAMA Neurol. 2018;75(7):808-17.
12. Khosrokiani Z, Letafatkar A, Hadadnezhad M, Sokhanguei Y. Comparison the Effect
of Pain Neuroscience and Pain Biomechanics Education on Neck Pain and Fear of Movement
in Patients with Chronic Nonspecific Neck Pain During the COVID-19 Pandemic. Pain Ther.
2022;11(2):601-11.
13. Javdaneh N, Saeterbakken AH, Shams A, Barati AH. Pain Neuroscience Education
Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic
Neck Pain. Int J Environ Res Public Health. 2021;18(16):8848
14. Kang H. Sample size determination and power analysis using the G* Power software.
J Educ Eval Health Prof. 2021;18.
15. Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive
neurophysiology education in chronic low back pain. Clinical J Pain. 2004;20(5):324-30.
16. Cuesta-Vargas AI, Neblett R, Chiarotto A, Kregel J, Nijs J, van Wilgen CP, et al.
Dimensionality and Reliability of the Central Sensitization Inventory in a Pooled
Multicountry Sample. Pain. 2018;19(3):317-29.
17. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191-7.
18. Scerbo T, Colasurdo J, Dunn S, Unger J, Nijs J, Cook C. Measurement Properties of
the Central Sensitization Inventory: A Systematic Review. Pain Pract. 2018;18(4):544-54.
Central Sensitization Inventory (CSI) as a treatment outcome measure for patients with
chronic spinal pain disorder in a functional restoration program. Spine J. 2017;17(12):1819-
29.
20. Noorollahzadeh K, Kahrizi S, Fesharaki MG, Heidarian M, Neblett R, Behzadipour S.
Cross-cultural adaptation and psychometric validation of the Persian version of the central
sensitization inventory. Musculoskelet Sci Pract. 2021;51:102314.
21. Montazeri A GA, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36):
translation and validation study of the Iranian version. Qual Life Res. 2005;14(3):875-82.
22. Jafari H, Lahsaeizadeh S, Jafari P, Karimi M. Quality of life in thalassemia major:
reliability and validity of the Persian version of the SF-36 questionnaire. J Postgrad Med.
2008;54(4):273.
23. Malfliet A, Kregel J, Meeus M, Cagnie B, Roussel N, Dolphens M, et al. Applying
contemporary neuroscience in exercise interventions for chronic spinal pain: treatment
protocol. Braz J Phys Ther. 2017;21(5):378-87.
24. Cheng CH, Su HT, Yen LW, Liu WY, Cheng HY. Long-term effects of therapeutic
exercise on nonspecific chronic neck pain: a literature review. J Phys Ther Sci.
2015;27(4):1271-6.
25. Nijs J, Meeus M, Cagnie B, Roussel NA, Dolphens M, Van Oosterwijck J, et al. A
Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience
Education With Cognition-Targeted Motor Control Training. Phys Ther. 2014;94(5):730-8.
26. Moseley L. Combined physiotherapy and education is efficacious for chronic low
back pain. Aust J Physiother. 2002;48(4):297-302.
27. Pires D, Cruz EB, Caeiro C. Aquatic exercise and pain neurophysiology education
versus aquatic exercise alone for patients with chronic low back pain: a randomized
controlled trial. Clin Rehabil. 2015;29(6):538-47.
chronic pain conditions in developed and developing countries: gender and age differences
and comorbidity with depression-anxiety disorders. J Pain. 2008;9(10):883-91.
29. Malfliet A, Kregel J, Meeus M, Danneels L, Cagnie B, Roussel N, et al. Patients With
Chronic Spinal Pain Benefit From Pain Neuroscience Education Regardless the Self-
Reported Signs of Central Sensitization: Secondary Analysis of a Randomized Controlled
Multicenter Trial. PM & R. 2018;10(12):1330-43.
30. Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al.
Pain physiology education improves health status and endogenous pain inhibition in
fibromyalgia: a double-blind randomized controlled trial. Clin J Pain. 2013;29(10):873-82.
31. Andias R, Neto M, Silva AG. The effects of pain neuroscience education and exercise
on pain, muscle endurance, catastrophizing and anxiety in adolescents with chronic idiopathic
neck pain: a school-based pilot, randomized and controlled study. Physiother Theory Pract.
2018;34(9):682-91.
32. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important
changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J
Pain. 2004;8(4):283-91.
33. Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al.
Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials:
IMMPACT recommendations. J Pain. 2008;9(2):105-21.