NEUROPHYSIOLOGICAL PAIN-EDUCATION FOR PATIENTS WITH CHRONIC LOW BACK PAIN – A SYSTEMATIC REVIEW AND META-ANALYSIS.

Review written by Steve Kamper info

BACKGROUND & OBJECTIVE

Clinical practice guidelines for people with back pain universally recommend education as the first line of treatment. This consistency suggests that the effectiveness of education as an intervention strategy is supported by a strong and coherent evidence base. However, details regarding the recommended content of education are often lacking from guidelines. This systematic review set out to investigate the effectiveness of a particular type of education. ‘Neurophysiological pain education’ involves teaching the patient about pain neurophysiology with the aim of correcting maladaptive illness beliefs and cognitions regarding their pain.

METHODS

The researchers searched biomedical databases to find randomised controlled trials that assessed the effectiveness of neurophysiological pain education as a treatment for adults with chronic back pain. The primary research question involved meta-analyses to estimate the pooled effects of education on pain and disability. They also looked at the effects on measures of beliefs such as fear of movement and catastrophizing. A secondary aim was to investigate whether different types of education intervention had different effects, and whether it made a difference if education was delivered individually or in groups. Along the way they did the usual systematic review practices like; double screening of the search results to make sure they didn’t miss any studies, double-checking data extraction to catch mistakes, assessment of risk of bias to make sure estimates are credible, and assessment of the overall quality of evidence to give an indication of how certain we can be about the size of the pooled effects.

RESULTS

They found 7 relevant RCTs, generally of fairly small size (total n=313) and methodological quality was mixed. None of the studies assessed the effect of education on its own, but rather education plus other interventions versus the other interventions alone.

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