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Objective: (1) This trial will compare the clinical and psychosocial effectiveness of in-group and individually pain neuroscience education (PNE) in patients with chronic low back pain (CLBP). In addition, (2) the influence of social determinants of health on post-treatment results will be analyzed. Methods: A three-arm randomized controlled trial will be conducted. Sixty-nine participants with CLBP will be recruited in a 1:1:1 ratio. Participants, assessor, and statistician will be blinded to group assignment. The PNE intervention will be adapted to the context of the participants. An experimental group (n = 33) will receive PNE in an in-group modality, the other experimental group (n = 33) will receive PNE in an individually modality and the control group (n = 33) will continue with usual care. Additionally, participants will be encouraged to stay active by walking for 20-30 min 3-5 times per week and will be taught an exercise to improve transversus abdominis activation (bracing or abdominal following). The outcome measures will be fear avoidance and beliefs, pressure pain threshold, pain self-efficacy, catastrophizing, pain intensity, and treatment expectation. Outcome measures will be collected at one-week before intervention, immediately post-intervention, and four-weeks post-intervention. Conclusion: The innovative approach of PNE oriented to fear beliefs proposed in this study could broaden the application strategies of this educational therapeutic modality. Impact. Contextualized PNE delivered by physical therapist could be essential to achieve a good cost-effectiveness ratio of this intervention to improve the clinical condition of people with CLBP.
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Dor Crônica , Dor Lombar , Neurociências , Educação de Pacientes como Assunto , Humanos , Dor Lombar/psicologia , Dor Lombar/terapia , Neurociências/educação , Educação de Pacientes como Assunto/métodos , Dor Crônica/terapia , Dor Crônica/psicologia , Masculino , Feminino , Adulto , Catastrofização/psicologia , Medição da Dor , Pessoa de Meia-Idade , Resultado do Tratamento , Autoeficácia , Terapia por Exercício/métodosRESUMO
OBJECTIVE: (1) To identify the characteristics of PNE programs in terms of teaching-learning strategies, session modality, content delivery format, number of sessions, total minutes and instructional support material used in patients with chronic musculoskeletal pain, (2) to describe PNE adaptations for patients with different educational levels or cultural backgrounds, and (3) to describe the influence of the patient's educational level or cultural background on the effects of PNE. METHODS: The PRISMA guideline for scoping reviews was followed. Nine databases were systematically searched up to July 8, 2023. Articles that examined clinical or psychosocial variables in adults with chronic musculoskeletal pain who received PNE were included. RESULTS: Seventy-one articles were included. Studies found benefits of PNE through passive/active teaching-learning strategies with group/individual sessions. However, PNE programs presented great heterogeneity and adaptations to PNE were poorly reported. Most studies did not consider educational level and culture in the effects of PNE. CONCLUSIONS: Despite the large number of studies on PNE and increased interest in this intervention, the educational level and culture are poorly reported in the studies. PRACTICAL IMPLICATIONS: It is recommended to use passive and/or active teaching-learning strategies provided in individual and/or group formats considering the patient's educational level and culture.
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Dor Crônica , Neurociências , Educação de Pacientes como Assunto , Humanos , Dor Crônica/terapia , Educação de Pacientes como Assunto/métodos , Neurociências/educação , Manejo da Dor/métodos , Aprendizagem , Escolaridade , Ensino , Dor Musculoesquelética/terapiaRESUMO
BACKGROUND: Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect. OBJECTIVES: To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP). METHOD: One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days). RESULTS: No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up). CONCLUSION: The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.
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Dor Crônica , Dor Lombar , Manipulação da Coluna , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Dor Lombar/terapia , Dor Lombar/psicologia , Resultado do Tratamento , Manipulação da Coluna/métodos , Manejo da Dor , Medo , Dor Crônica/terapiaRESUMO
OBJECTIVE: To compare the effectiveness of pain neuroscience education (PNE) versus biomedical education (BME) in a rehabilitation program following arthroscopic rotator cuff repair (ARCR) in patients with chronic shoulder pain. METHODS: Twenty-nine patients who participated in a rehabilitation program were randomly assigned to either an experimental PNE group (N = 16) or a control BME group (N = 13). Measurements included pain intensity at rest and in movement, pain catastrophizing, kinesiophobia, disability and health-related quality of life (HRQoL). Outcomes were evaluated at baseline and at 4 and 8 weeks after the intervention. RESULTS: A main effect for time was observed for: intensity of pain at rest (p < .01); pain with movement (p < .01); pain catastrophizing (p < .01); kinesiophobia (p < .01); disability (p < .01); and HRQoL (p < .01). No group interactions were significant for any variable, except for pain with movement, which favored the PNE group (p = .03). Large effect sizes (ranging from d = 0.79 to d = 2.65) were found for both interventions in all outcomes. CONCLUSION: A rehabilitation program including either PNE or BME are equally effective in improving rest pain, pain catastrophizing, kinesiophobia, disability, and HRQoL in patients after ARCR, except for pain at movement in favor of the PNE group. The inclusion of PNE in the rehabilitation program appears to lead to clinically meaningful improvements in pain at rest in short term when treating patients with ARCR.
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Lesões do Manguito Rotador , Manguito Rotador , Humanos , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/cirurgia , Lesões do Manguito Rotador/reabilitação , Resultado do Tratamento , Qualidade de Vida , Dor Pós-OperatóriaRESUMO
Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women's lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.
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BACKGROUND: Pain education resources for children using appropriate language and illustrations remain scarce. OBJECTIVES: We aimed to summarize the development process and testing for face and content validity of a structured comic book about pain education for children. METHODS: A first draft of a comic book was developed (Portuguese and English) based on pain education concepts. Experts in pediatric pain from different countries analyzed content, objectives, language, illustrations, layout, motivation, and cultural adjustment. A third draft developed in Portuguese considering experts' suggestions was presented to children and parents in Brazil. The total adequacy score was calculated from the sum of the scores obtained in each domain, divided by the maximum total score. Descriptive analysis is presented. RESULTS: The expert panel was composed of 11 (64.7%) physical therapists, and 6 (35.3%) psychologists. The total adequacy score (0-100%) was 87.74%. The third draft version of the comic book was presented to 28 children and the final version was presented to 16 children with a mean age of 9.6 years. Children were totally satisfied (n=4; 26.7%) or satisfied (n=9; 56.2%) with the story of the comic book. The readability of the comic book was considered suitable for grades 4 to 6 educational level. CONCLUSION: The comic book "A Journey to Learn about Pain" was validated for face and content validity by the expert panel and the Brazilian target population. This comic book is available in Portuguese and English and can be a potentially useful resource for children.
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Livros , Pais , Brasil , Criança , Escolaridade , Humanos , Dor , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: Postherpetic neuralgia (PHN) is a complex neuropathic painful condition in which pain is a direct consequence of the response to peripheral nerve damage experienced during herpes zoster attack. PHN is the most common chronic complication of herpes zoster and it causes considerable suffering, affecting the physical functioning and psychological well-being of patients. OBJECTIVE: To describe the effect of a conservative treatment using pain neuroscience education (PNE) and transcutaneous electrical nerve stimulation (TENS) in a patient with trigeminal PHN. CASE DESCRIPTION: A 67-year-old woman sought care for pain, dysfunction, and sensory loss in the left jaw. The assessment included: 1) pain, using the numerical pain rating scale (NPRS), pressure pain threshold (PPT), Douleur Neuropathique 4 (DN4), McGill Pain Questionnaire (MPQ), Graded Chronic Pain Scale (GCPS), and classic body charts of the cranial region; 2) somatosensory function, by means of mechanical detection threshold (MDT) and pressure pain threshold (PPT); 3) jaw function, using the Jaw Functional Limitation Scale-20 (JFLS-20); and 4) psychosocial features, by means of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorders Questionnaire-7 (GAD-7). Treatment consisted of 12 sessions of PNE and TENS. OUTCOMES: After treatment, a clinically significant improvement in NPRS, DN4, MDT, GCPS, and PHQ-9 was observed. CONCLUSION: In this case report, a treatment based on the combination of PNE and TENS seemed to have contributed to improving pain, sensory abnormalities, and jaw function. Psychosocial factors also showed a trend to improve after the treatment.
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Herpes Zoster , Neuralgia Pós-Herpética , Neuralgia , Estimulação Elétrica Nervosa Transcutânea , Idoso , Feminino , Herpes Zoster/complicações , Herpes Zoster/terapia , Humanos , Neuralgia Pós-Herpética/complicações , Neuralgia Pós-Herpética/diagnóstico , Neuralgia Pós-Herpética/terapia , Medição da Dor , Estimulação Elétrica Nervosa Transcutânea/efeitos adversosRESUMO
Introducción: El síndrome del dolor lumbar (SDL) es una de las causas principales de discapacidad a nivel mundial. La educación sobre el dolor es un tratamiento posible, sin embargo, se desconocen las herramientas disponibles para pacientes con dolor lumbar. Objetivo: Describir las estrategias de educación sobre el dolor en personas con SDL descritas en la literatura científica y gris en los últimos 10 años. Metodología: Revisión exploratoria en las bases de datos MEDLINE/PubMed, CINAHL/EBSCO, Scielo y en Google Académico. Se filtraron por título, resumen y texto completo; incluyendo estudios que reportaran estrategias de educación sobre el dolor lumbar, en inglés o español, publicados en los últimos 10 años y cuyo texto completo estuviera disponible. Se excluyeron estudios en población infantil, adolescentes, animales, embarazadas, pacientes pre y post operatorio, cáncer, y revisiones sistemáticas. Resultados: De un total de 760 artículos, se incluyeron 42 artículos en esta revisión. Se identificaron 33 estrategias de abordaje de educación del dolor lumbar, clasificándose en tres categorías según la forma de entrega del programa de educación; a)presencial, b)no presencial y c)mixtas. Una misma estrategia puede incorporar diferentes instrumentos, siendo las estrategias más frecuentes Educación en neurofisiología del dolor (PNE). Conclusiones: Existen numerosas estrategias para la educación sobre el dolor lumbar, diferenciándose en su metodología y contenido. Futuras investigaciones deberían enfocarse en sus efectos, como una alternativa de terapia no invasiva y complementaria a los tratamientos habituales.
Introduction: Low back pain syndrome (LBP) is one of the leading causes of disability worldwide. Education about pain is a possible treatment, however, the strategies are unknown for patients with low back pain. Objective: Describe the pain education strategies in people with LBP described in the scientific and gray literature in the last 10 years. Methods: Exploratory review in the databases MEDLINE / PubMed, CINAHL / EBSCO, Scielo and in Google Scholar. They were filtered by title, abstract and full text; including studies that reported education strategies for LBP, in English or Spanish, published in the last 10 years and whose full text was available. Studies in children, adolescents, animals, pregnant women, pre- and post-operative patients, cancer, and systematic reviews were excluded. Results: Out of a total of 760 articles, 42 articles were included in this review. Thirty-three strategies for the education approach LBP were identified, classified into three categories according to the delivery method of the education program; a) face-to-face, b) non-face-to-face and c) mixed. The same strategy can incorporate different instruments, the most frequent strategy is Education in the Neurophysiology of Pain. Conclusions: There are numerous strategies for education about low back pain, differing in their methodology and content. Future research should focus on its effects, as a non-invasive therapy alternative and complementary to the usual treatments.
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ABSTRACT BACKGROUND AND OBJECTIVES: During the undergraduate course students have the opportunity to learn and understand health promotion and prevention, quality of life and other concepts, but they rarely learn about health education, let alone pain. Knowing that there are gaps in the training of health professionals regarding pain, and in the use of pedagogical methodologies that encourage the active construction of knowledge, the objective of this study was to provide an experience about the process of understanding pain neuroscience education from an instrument and the role-playing technique in the academic environment of Physiotherapy students. CASE REPORTS: During a Basic Complexity class, Physiotherapy students from the Ceilândia campus of the University of Brasília were invited to provide care to a fictitious population and develop explanations and lessons about pain and its processes in the human body using the WHOQOL-Bref questionnaire to evaluate the quality of life of the individual and target the care accordingly. CONCLUSION: The experience provided by the simulation of clinical cases was important for the analysis and discussion of challenging issues such as psychological, social and behavioral factors in the health education process in multi and interdisciplinary interventions.
RESUMO JUSTIFICATIVA E OBJETIVOS: Durante a graduação, os acadêmicos têm a oportunidade de aprender e compreender sobre promoção e prevenção de saúde, qualidade de vida, entre outros conceitos, mas raramente a educação em saúde é colocada nas salas de aula, em especial o entendimento da dor. Sabendo que há lacunas na formação de profissionais de saúde relacionadas ao conhecimento da dor e à utilização de metodologias pedagógicas que incentivem a construção ativa do conhecimento, o objetivo deste estudo promoveu um relato de experiência sobre o processo de entendimento e educação em neurociência da dor, por meio de um instrumento e da técnica de dramatização na vivência acadêmica de estudantes de Fisioterapia. RELATO DOS CASOS: Durante a realização de uma aula de Básica Complexidade, alunos do curso de Fisioterapia da Universidade de Brasília - Campus Ceilândia, foram convidados a vivenciarem um atendimento à uma população fictícia e desenvolverem explicações e ensinamentos sobre a dor e seus processos no corpo humano, utilizando o instrumento WHOQOL-Bref para avaliar a qualidade de vida do indivíduo e direcionar o seu atendimento. CONCLUSÃO: A experiência vivenciada por meio de simulações de casos clínicos na disciplina foi importante para a análise e discussão de questões desafiadoras como fatores psicológicos, sociais, e comportamentais no processo de educação em saúde em intervenções multi e interdisciplinar.
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BACKGROUND: Current treatment for adults with chronic pain often includes Pain Neuroscience Education (PNE) to make people understand the nature underlying their pain and thus provides a clear rational for a biopsychosocial approach. Despite recommendations to use Pain Neuroscience Education as well in children with chronic pain, a specific program, tailored to children aged 6-12 years is lacking. OBJECTIVES: The aim of this study was to develop a Pain Neuroscience Education program for children with chronic pain and test its feasibility. METHODS: First the internet and scientific literature was searched for sources (e.g., books, videos, etc.) that might be supportive in teaching children about the neurophysiology of pain. Based on this content, we developed a Pain Neuroscience Education program for children, 'PNE4Kids', which was tested for feasibility in three groups of healthy children (n=18; 9 girls and 9 boys) aged between 6 and 12 years old. RESULTS AND CONCLUSIONS: This paper provides both scientists and clinicians with a specific program to explain the neurophysiology of pain to children with chronic pain, since it is past high time to use a modern neuroscience approach in this vulnerable population. Further research should examine the effectiveness of this developed PNE4Kids program on pain-related outcomes in children with chronic pain. Registration number: NCT02880332 (https://clinicaltrials.gov/ct2/show/NCT02880332).
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Dor Crônica/terapia , Manejo da Dor/métodos , Criança , Protocolos Clínicos , Humanos , NeurociênciasRESUMO
BACKGROUND: Nonspecific chronic spinal pain is a common problem within the chronic pain population and is characterized by high social, economic and personal impact. To date, therapists are still struggling in adequately treating these types of patients, as seen in the small and short-term benefits of frequently applied primary care treatments. It is remarkable that despite the well-documented presence of abnormalities in central nociceptive processing in nonspecific chronic spinal pain patients, the implementation of this knowledge in clinical practice is still nearly non-existent. METHODS: This paper provides the treatment protocol used in a large randomized controlled trial that aimed to assess the effectiveness of a modern neuroscience approach compared to usual care evidence-based physiotherapy. This comprehensive pain neuroscience treatment program combines pain neuroscience education and cognition-targeted exercise therapy. CONCLUSION: Based on previous small-scaled studies, this treatment protocol is expected to normalize central alterations by addressing central nervous system dysfunctions, psychological factors, as well as peripheral dysfunctions in a broader biopsychosocially-driven framework.