A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability

Abstract

Background and objective: Pain neuroscience education (PNE) has shown promising ability in previous reviews to improve pain and disability in chronic low back pain (CLBP). This review aimed to evaluate randomized controlled trials comparing the effectiveness of PNE on pain and disability in CLBP.

Databases and data treatment: A systematic search was performed using the databases of EBSCO, Medline, Cochrane and Web of Science. Meta-analysis was performed using the RevMan 5.1 software to pool outcomes using the random effects model, weighted mean differences (WMD), standard deviation, 95% confidence intervals and sample size. GRADEpro software was utilized to calculate overall strength of evidence.

Results: A total of 6,767 papers were found, eight were included (n = 615). Meta-analysis for short-term pain (n = 428) demonstrated a WMD of 0.73 (95%CI -0.14, 1.61) on a ten-point scale of PNE against no PNE (GRADE analysis low evidence). When PNE alongside physiotherapy interventions were grouped for pain (n = 212), a WMD of 1.32 was demonstrated (95% CI 1.08, 1.56, p < 0.00001; GRADE analysis moderate evidence). Short-term disability (RMDQ) meta-analysis demonstrated a WMD of 0.42 (95%CI 0.28, 0.56; p < 0.00001; n = 362; GRADE analysis moderate evidence); whereas the addition of PNE to physiotherapy interventions demonstrated a WMD of 3.94 (95% CI 3.37, 4.52; p < 0.00001; GRADE analysis moderate evidence.

Conclusion: This review presents moderate evidence that the addition of PNE to usual physiotherapy intervention in patients with CLBP improves disability in the short term. However, this meta-analysis failed to show evidence of long-term improvement on pain or disability when adding PNE to usual physiotherapy.

Significance: This review demonstrates moderate level evidence that the use of pain neuroscience education alongside physiotherapy interventions probably improves disability and pain in the short term in chronic low back pain. These results provide greater support for the addition of pain neuroscience education in routine physiotherapy practice in chronic low back pain.