Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 May 1;163(5):852-860.
doi: 10.1097/j.pain.0000000000002436.

Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial

Elizabeth Lane  1 , John S Magel  1 , Anne Thackeray  1 , Tom Greene  2   3 , Nora F Fino  4 , Emilio J Puentedura  5 , Adriaan Louw  6 , Daniel Maddox  7 , Julie M Fritz  1   8
Affiliations
Randomized Controlled Trial

Effectiveness of training physical therapists in pain neuroscience education for patients with chronic spine pain: a cluster-randomized trial

Elizabeth Lane et al. Pain. .

Abstract

Chronic spinal pain poses complex challenges for health care around the world and is in need of effective interventions. Pain neuroscience education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions, and expectations about pain. Pain neuroscience education has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but understudied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain. The cluster-randomized clinical trial took place in 45 outpatient physical therapist (PT) clinics. Participants included 108 physical therapists (45 clinics and 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC). We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System Physical Function computer adaptive test {mean difference = 1.05 (95% confidence interval [CI]: -0.73 to 2.83), P = 0.25}. The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared with no intervention (mean difference = 3.65 [95% CI: 0.00-7.29], P = 0.049 and = 3.08 [95% CI: 0.07 to -6.09], P = 0.045, respectively). However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks. Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over UC PT.

Trial registration: ClinicalTrials.gov NCT03168165.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement

E. Lane, D. Maddox, and A. Louw receive royalties or other payments for the teaching of material related to the content of this article. All other authors have no conflicts of interest.

Figures

Figure 1.
Figure 1.
CONSORT flow diagram. PNE, pain neuroscience education; PT, physical therapist; UC, usual care.
See this image and copyright information in PMC

References

    1. Adams G, Gulliford MC, Ukoumunne OC, Eldridge S, Chinn S, Campbell MJ. Patterns of intra-cluster correlation from primary care research to inform study design and analysis. J Clin Epidemiol 2004;57:785–94. - PubMed
    1. Baird AJ, Haslam RA. Exploring differences in pain beliefs within and between a large nonclinical (workplace) population and a clinical (chronic low back pain) population using the pain beliefs questionnaire. Phys Ther 2013;93:1615–24. - PubMed
    1. Bandura A, Adams NE. Analysis of self-efficacy theory of behavioral change. Cog Ther Res 1977;1:287–310.
    1. Beltran-Alacreu H, López-De-uralde-villanueva I, Fernández-Carnero J, La Touche R. Manual therapy, therapeutic patient education, and therapeutic exercise, an effective multimodal treatment of nonspecific chronic neck pain: a randomized controlled trial. PM R 2015;94:887–97. - PubMed
    1. Beneciuk JM. Low back pain: clinical practice guidelines. J Orthop Sports Phys Ther 2014;44:1000.

Publication types

Associated data