Pain resilience therapy vs. pain neuroscience education for adults with chronic low back pain: secondary analysis of data from a randomized controlled trial of risk and resilience factors

Key Points

1. In adults with chronic low back pain, Pain Resilience Therapy led to greater improvement than Pain Neuroscience Education on 8 of 11 psychological measures at 90 days, including pain catastrophizing, kinesiophobia, and pain acceptance.

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BACKGROUND & OBJECTIVE

Psychological factors such as catastrophizing, fear of movement, and anxiety are associated with worse outcomes in chronic low back pain (LBP). Researchers are also interested in resilience factors, such as pain acceptance and self-efficacy, which may protect against poor outcomes.

Pain Neuroscience Education (PNE) is a common treatment that teaches patients about the biology of pain. Pain Resilience Therapy (PRT) is a newer approach that focuses on building a patient's strengths and resources. It draws on positive psychology and exposure-based learning.

This study is a secondary analysis of a randomized controlled trial comparing PRT to PNE. The parent trial reported results for pain intensity and pain interference. This analysis examined psychological risk and resilience factors.

Psychological factors such as catastrophizing, fear of movement, and anxiety are associated with worse outcomes in chronic low back pain.

The study suggests that approaches that work on acceptance, gradual engagement with feared activities, and personal strengths may do better than pain neuroscience education for managing chronic pain.

METHODS

• 72 adults with LBP lasting at least six months were randomly assigned to PRT or PNE. 60 participants (30 per group) completed the study and were included in the analysis.

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