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

Research paper by L L Wood, P P Hendrick

Indexed on: 05 Sep '18Published on: 05 Sep '18Published in: European Journal of Pain



Abstract

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 randomised controlled trials comparing the effectiveness of PNE on pain and disability in CLBP. 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 utilised to calculate overall strength of evidence. 6767 papers were found, 8 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 was 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. 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.