Journal of Pain Research (Nov 2020)
Effect of Additional Pain Neuroscience Education in Interdisciplinary Multimodal Pain Therapy on Current Pain. A Non-Randomized, Controlled Intervention Study
Abstract
Michael Richter,1 Christian Rauscher,2 Alexander Kluttig,3 Joachim Mallwitz,4 Karl-Stefan Delank5 1Physiotherapie Am Michel, Hamburg, Germany; 2Rückenzentrum St. Georg, Asklepios Klinik St. Georg, Hamburg, Germany; 3Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther-University, Halle-Wittenberg, Halle, Germany; 4Rückenzentrum Am Michel, Praxis Für Orthopädie, Hamburg, Germany; 5Universitätsklinikum (Halle), Department Für Orthopädie, Unfall- Und Wiederherstellungschirurgie, Martin-Luther-Universität, Halle-Wittenberg, Halle, GermanyCorrespondence: Alexander KluttigMartin-Luther-University, Halle-Wittenberg, Institute for Medical Epidemiology, Biometrics and Informatics, Halle (Saale) 06097, GermanyTel +49 (0)345 557-3570Fax +49 (0)345 557-3580Email [email protected]: Interdisciplinary multimodal pain therapy (IMPT) programs for chronic back pain are effective and recommended. The patient-centered and biopsychosocial nature of IMPT is grounded in contemporary understanding that chronic pain states reflect heightened sensitization of the nervous system rather than an issue in the tissue. Teaching patients about pain is part of IMPT programs, though a clinical guideline is lacking. This study aims to answer the following question: Does the addition of an evidence-based pain neuroscience education (PNE) lecture for patients, into an IMPT program, produce superior results than the IMPT program itself?Patients and Methods: A non-randomized, controlled intervention study was performed with 179 back pain patients indicated for IMPT. Intervention group (N=102) received a four-week IMPT program, which contained 4 one-hour sessions PNE. Control group (N=77) received the same IMPT without the additional PNE. Primary outcome was current pain after intervention. Pain knowledge, physical function, depression, anxiety, stress, quality of life and fear-avoidance were analyzed as secondary outcomes. Outcomes were defined as change of the parameter measured before and immediately after the four-week IMPT. For each outcome, linear regression models were used to estimate the raw and adjusted (sex, age and BMI) effect of additional PNE.Results: Despite improvement in all outcomes for both groups during the treatment phase, the implemented PNE did not result in additional pain reduction (regression coefficient for PNE effect on pain level 0.34; 95% CI − 6.23– 6.97). Between-group differences could only be shown for pain-related knowledge in favor for the intervention group (0.78; 95% CI 0.35– 1.20).Conclusion: The additional PNE lecture did not lead to pain reduction beyond the usual IMPT. However, the PNE did increase pain-related knowledge and, therefore, might be helpful in coping with pain after the IMPT program.Keywords: interdisciplinary multimodal pain therapy, pain neuroscience education, chronic back pain, neurophysiology of pain, pain management
