Neurophysiological Pain Education for Patients With Chronic Low Back Pain: A Systematic Review and Meta-Analysis

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Objective:To evaluate the effect of neurophysiological pain education (NPE) for patients with chronic low back pain (CLBP).Methods:A systematic search was performed in 6 electronic databases. Eligible randomized-controlled trials were those with at least 50 % of patients with CLBP and in which NPE was compared with no intervention or usual care. Methodological quality was assessed independently by 2 of the authors using the Cochrane Collaboration Risk of Bias Tool. The effect of NPE was summarized in a random effect meta-analysis for pain, disability, and behavioral attitudes. Effect was estimated as weighted mean difference (WMD) if outcomes were on the same scale or as standardized mean difference (SMD). The overall quality of evidence was evaluated according to GRADE guidelines.Results:Seven randomized-controlled trial studies (6 low and 1 high quality) were included. Statistically significant differences in pain, in favor of NPE, were found after treatment, WMD=−1.03 (95% confidence interval [CI], −0.55 to −1.52), and after 3 months, WMD=−1.09 (95% CI, −2.17 to 0.00). Furthermore statistically significant lower disability was found in the NPE group after treatment, SMD=−0.47 (95% CI, −0.80 to −0.13) and after 3 months SMD=−0.38 (95% CI, −0.74 to −0.02). The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=−5.73 (95% CI, −13.60 to 2.14) and after 3 months WMD=−0.94 (95% CI, −6.28 to 4.40).Discussion:There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. NPE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP.

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