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Randomized Controlled Trial
. 2023 Sep-Oct;27(5):100555.
doi: 10.1016/j.bjpt.2023.100555. Epub 2023 Oct 13.

Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial

Fernando Augusto Gonçalves Tavares  1 , João Vitor Alves Rossiter  2 , Gabriela Caroline Leandro Lima  2 , Letícia Gomes de Oliveira  2 , Witor Souza Cavalcante  2 , Mariana Arias Ávila  3 , Steven Zachary George  4 , Thais Cristina Chaves  5
Affiliations
Randomized Controlled Trial

Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial

Fernando Augusto Gonçalves Tavares et al. Braz J Phys Ther. 2023 Sep-Oct.

Abstract

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.

Keywords: Chronic low back pain; Disability; Pain intensity; Pain neuroscience education; Spinal manipulative therapy.

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Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
A. Global low-amplitude and high-speed manipulative maneuver (thoracic region). B. Posterior-anterior central mobilization administered in the low back region.
Fig 2
Fig. 2
Flowchart describing the number of participants through the study. SMT, spinal manipulative therapy group; PNE, pain neuroscience education.
See this image and copyright information in PMC

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