Effect of Pain Neuroscience Education on pain perception in adult individuals with chronic non-specific low back pain – A Randomized Controlled Trial

According to The International Association for the Study of Pain, Chronic non-specific low back pain is pain experienced between the lower ribcage and buttock creases which can extend into the legs, that persists or recurs for longer than 3 months, is associated with emotional distress and/or functional disability and symptoms that cannot be better accounted for by another diagnosis, such as tissue damage or a disease process. The consequences of chronic non-specific low back pain extend beyond physical discomfort, with increased anxiety and depression consequently impacting social, recreational, and work life of individuals. Psycho-social factors such as kinesiophobia, fear avoidance, and pain-catastrophizing behaviours are significant in determining the course of low back pain and its shift from acute towards chronic pain. Limiting beliefs not only make pain worse but also make therapeutic interventions and rehabilitation initiatives less successful. A holistic approach centred on the bio-psycho-social model of care is thus most beneficial for individuals with chronic non-specific low back pain. Pain Neuroscience Education is an educational strategy within the bio-psycho-social model of care for individuals with pain-related musculoskeletal conditions, which fits into the International Classification of Functioning, Disability & Health criteria. Pain Neuroscience Education is intended to help people reconceptualize their pain, desensitize their nervous system and change their pain-related beliefs and behaviours for the better. Studying the effect of Pain Neuroscience Education on pain perception is essential to strengthen the understanding of chronic pain management and potentially enhance the quality of care provided to individuals with chronic non-specific low back pain.

Ai    Aim: To study the effect of Pain Neuroscience Education on pain perception in adult individuals with chronic nonspecific low back pain

Primary Objectives:

(Control Group: Adult individuals with chronic non-specific low back pain receiving Standard of Care Physiotherapy. Experimental Group: Adult individuals with chronic non-specific low back pain receiving Pain Neuroscience Education along with Standard of Care Physiotherapy)

1. To assess Pain using Numerical Rating Scale and Pain Pressure Threshold Algometer, Functional Status using Roland Morris Disability Questionnaire, Fear of Movement using Tampa Scale of Kinesiophobia -11 and Pain Catastrophizing using Pain Catastrophizing Scale, pre and post intervention in control group and experimental group

2. To compare pre and post intervention values of pain, functional status, fear of movement, and pain catastrophizing in control group

3. To compare pre and post intervention values of pain, functional status, fear of movement, and pain catastrophizing in experimental group

4. To compare post intervention values of pain, functional status, fear of movement, and pain catastrophizing between control group and experimental group

Intervention & Procedure:

Intervention duration: 2 Weeks (Follow up thrice a week, alternate days). Both the control group as well as the experimental group will receive a total of 6 sessions in the study.

Control group: The individuals will receive standard of care physiotherapy only. (Patient education regarding importance of exercise and ergonomic advice; range of motion, stretching, and strengthening exercises; adjuvant therapy in the form of electrotherapeutic modalities as indicated).

Experimental group: The experimental group will receive ‘Pain Neuroscience education’, via a 4 minute, 30 seconds long video. The video is licensed under the terms of the Creative Commons Attribution Non-commercial license, which permits unrestricted non-commercial use, distribution and reproduction in any medium, remixed or adapted, provided the original work is properly cited. The original video in English has been translated into Marathi and Hindi. This will be followed by standard of care physiotherapy.

Pre and post assessment of participants will be done by assessor from peer group.