Development validation and evaluation of the effectiveness of pain neuroscience education PNE booklet on pain function and quality of life in patients with chronic musculoskeletal pain A mixed method study

Introduction: Chronic musculoskeletal (MS) pain, is the leading cause of disability globally. The World Health Organization (WHO) estimates that 20–33% of the world’s population suffers from chronic musculoskeletal pain, affecting approximately 1.75 billion people worldwide. More or less irreversible state of hyperexcitability within the central nervous system, known as nonneuropathic central sensitization pain (CS), is present in patients with chronic pain. Changes in the pain neuromatrix, modulating pain processes by behavioral, emotional, social, and cognitive factors are related to CS. Emotions, thoughts, attention and stress can influence the pain facilitating pathways causing cognitive emotional sensitization leading to activation of the pain neuromatrix, increased pain, affective distress, pain-related disability, and poorer treatment outcomes. In this light, treating chronic pain presents a considerable challenge for health care professionals, who should incorporate biopsychosocial (BPS) approach that address biological, psychological and social factors into their treatment plan. PNE provides the patient with a thorough understanding of the neurobiological and neurophysiological processes involved in their pain experience. PNE uses metaphors and stories; that helps to provide patients with an opportunity to improve their understanding of pain and reconceptualize their ideas about it, thereby changing the negative beliefs they have about pain and their incorrect perceptions of it. 

Need: Research has shown the ambiguous nature of delivering PNE in chronic MS pain. This requires the need of developing PNE program for chronic MS pain that could be helpful for physiotherapists in their day-to-day clinical practise.

Aim: To use the current best evidence for Pain Neuroscience Education for chronic MS pain to develop and validate a neuroscience educational booklet for chronic MS pain.

Significance: It’s noteworthy that a significant proportion of individuals dealing with chronic MS pain are unfamiliar with appropriate course of care to follow. Pain Neuroscience Education (PNE) can be viewed as an additional clinical resource that aids clinicians in managing the complexities of treating chronic MS pain. If patients perceive pain and stress as outcomes of a sensitive nervous system rather than tissue damage or pathological physiology, they may find themselves more willing to pursue active therapies they typically avoid. Such an approach could contribute to holistic wellness and comprehensive rehabilitation in cases of chronic MS pain. The creation and utilization of booklets align with studies on patient education, emphasizing their significance as valuable tools for enhancing information retention compared to relying solely on verbal communication. Booklets are not only cost-effective and straightforward but also widely favoured as a method of conveying healthcare information to patients. Hence, it can be used to positively impact compliance, alleviate anxiety, depression and empower patients.

Objectives: To develop and study effectiveness of PNE booklet on pain, function and quality of life in patients with chronic MS pain.

Method:

o   Type of the study:  A mixed method study

o   Study         participants:    Individuals suffering from chronic musculoskeletal pain

o   A booklet will be developed by obtaining experts’ evaluation and suggestions. (Modified Delphi approach)

o   Written consent from the participants shall be obtained.

o   Prepared PNE booklet will be given to participants for evaluation.

o   Individuals having chronic musculoskeletal pain will be randomly allotted in to two groups. Control group will receive traditional physiotherapy treatment for chronic musculoskeletal pain whereas experimental group will receive PNE booklet along with traditional physiotherapy treatment. Various outcome measures will be utilized to study the effectiveness of PNE booklet on pain, function and quality of life.

Data analysis: Descriptive and exploratory data analysis will be performed on the total data set collected which may include parametric and non-parametric tests, chi-square test, correlation coefficient and multivariate/linear regression analysis. 95% CI will be considered for statistical analysis. Statistical analysis will be done by using SPSS version 20.0.