BLENDED LEARNING IS AN EFFECTIVE APPROACH IN PAIN NEUROSCIENCE EDUCATION IN CHRONIC SPINAL PAIN PATIENTS

Malfliet A.^1,2,3,4, Huysmans E.⁵, Kregel J.^1,2,3, Meeus M.^1,3,6, Danneels L.³, Roussel N.⁶, Cagnie B.³, Dolphens M.³, Nijs J.^1,2,4

¹Pain in Motion, Brussels, Belgium, ²Vrije Universiteit Brussel, Department of Physiotherapy, Human Physiology and Anatomy, Brussels, Belgium, ³Ghent University, Department of Rehabilitation Sciences and Physiotherapy, Ghent, Belgium, ⁴University Hospital Brussels, Brussels, Belgium, ⁵Vrije Universiteit Brussel, Brussels, Belgium, ⁶Antwerp University, Department of Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium

Background: In the last decade, attention for Pain Neuroscience Education (PNE) has increased remarkably. PNE aims at explaining the underlying physiology of chronic pain to increase the patients' understanding of the pain problem. PNE covers working mechanisms of both the peripheral and central nervous system and their changes in chronic pain (e.g. neuroplasticity). The effectivity of PNE in improving health status, pain beliefs, endogenous pain inhibition etc. is well-established in several chronic pain populations, like chronic fatigue syndrome, chronic low back pain and chronic whiplash, but all these studies were limited by a small sample size. This study is therefore the first one to evaluate PNE in a sufficiently powered protocol. Additionally, this study makes use of blended learning by providing the information partly using an online session. This is an innovative and cost-effective approach, which is useful for clinical practice.

Purpose: This study was conducted to investigate the effectiveness of partial e-learning pain neuroscience education in chronic spinal pain patients.

Methods: 120 patients with non-specific chronic spinal pain were included in this study and were randomized into the control (n=60) or experimental (n=60) group. Baseline and post-education assessment included several self-reported questionnaires, measuring kinesiophobia, pain catastrophizing, illness perceptions, pain disability and pain awareness. Both groups received three sessions of education, including a group session, an online session and a one-on-one session (e.g. blended learning). The experimental group was educated on pain neurophysiology, leading to a reconceptualization of their pain beliefs as they were thought that all pain originates in the brain. The control group received regular back/neck school with coverage of anatomy, physiology and biomechanics of the spine.

Results: Both groups showed a significant amelioration in pain catastrophizing and pain awareness, regardless the type of therapy they received. However, only the group that received pain neuroscience education showed a significant reduction in kinesiophobia (fear of movement or re-injury) and a significant improvement of several aspects of illness perceptions, which was not seen in the control group.

Conclusion(s): This is the first sufficiently powered study to demonstrate the effectiveness of PNE. Additionally, it is the first study to demonstrate its’ effectiveness in the chronic spinal pain population, as neck pain patients were never considered before in research.

Implications: This study has several implications. First, chronic spinal pain patients should be educated on the underlying pain neurophysiological mechanisms of their chronic pain rather than being educated on the biomechanical aspects of spinal pain. Second, blended learning (the combination of personal contact and online learning) seems to be a useful approach in delivering pain neuroscience education. Not only is it proven to be an effective method, it is also a time-effective method in daily clinical practice. Last, also in physiotherapy education there should be enough attention for educating the student on the neurophysiological mechanisms behind chronic pain as well as training them in transferring this knowledge to the patient.

Funding acknowledgements: Anneleen Malfliet: PhD research fellow - FWO, Belgium.
Jeroen Kregel & Mieke Dolphens: IWT-TBM, Belgium.

Topic: Musculoskeletal: spine

Ethics approval: Approval to conduct this study was granted by the Ethics Committee of Ghent University Hospital and University Hospital Brussels.

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