PAIN NEUROSCIENCE EDUCATION AND GRADED EXPOSURE VERSUS PILATES AND POSTURAL EDUCATION IN WORKERS WITH CHRONIC NON-SPECIFIC LOW BACK PAIN

S. Martins Alves¹, R. Andias¹, E. Puentedura², A. Gonçalves da Silva^1,3

Background: Chronic Low Back Pain (CLBP) has a high prevalence and is a leading cause of disability, absenteeism and sick leave among workers. It is a multifactorial and multidimensional condition, but psychosocial factors are believed to play an important role in its long-term maintenance. Exercise and education are two of the physiotherapy interventions most commonly recommended in relevant guidelines. However, it is unclear whether an exercise type or educational approach is better than the other. Pain Neuroscience Education (PNE) and graded exposure are cognitive-behavioral intervention approaches that target the psychosocial aspect of CLBP. In contrast, Pilates is a more biomechanical and postural approach that is commonly used in individuals with CLBP.

Purpose: The main objective was to compare the effectiveness of PNE and graded exposure against Pilates and postural education on disability in paper industry workers with CLBP. The secondary aim was to compare both interventions for pain intensity, catastrophizing, fear-avoidance beliefs, sleep, endurance of back extensor muscles, knowledge of pain neuroscience, and patients’ perceived impression of change.

Methods: A total of 26 workers with CLBP were randomly assigned to one of the two intervention groups: PNE and graded exposure or Pilates and postural education.  Participants were assessed before, after the intervention, and at 3 months-follow-up using the Oswestry Disability Index, the Numeric Pain Rating Scale, the Pain Catastrophizing Scale, the Fear-Avoidance Beliefs Questionnaire, the Medical Outcomes Study Sleep Scale, the Biering-Sørensen test, and the Neurophysiology of Pain Questionnaire. After the intervention, they were also asked to fill in the Patients’ Global Impression of Change. Both groups received a 1-hour session for 8 weeks, which was administered in the physiotherapy office of the paper industry. PNE and graded exposure were tailored to the occupational context.

Results: Both interventions had a positive and similar impact on disability (p<0,001), pain intensity, fear-avoidance at work, and on the Sleep Index II (p<0,05), at post-intervention. PNE and graded exposure was superior to Pilates and postural education for catastrophizing, fear-avoidance of physical activity, endurance of back extensor muscles and knowledge of pain neuroscience (p<0,05). Post-intervention improvements were maintained at 3 months follow-up (p<0,05). In the PNE group, 72,7% participants at post-intervention and 62,5% at 3 months-follow-up perceived themselves as moderately to a great deal better. In contrast, 33,3% of the participants at post-intervention and 38,5% at 3 months-follow-up in the Pilates group perceived themselves as moderately to a great deal better.

Conclusion(s): This study provides preliminary evidence that PNE and graded exposure for CLBP is superior to Pilates and postural education for catastrophizing, fear-avoidance beliefs and patients’ perceived impression of change in workers with CLBP.

Implications: This study findings suggest that PNE and graded exposure can be administered in a occupational context as specific and physically demanding as a paper industry, and that it should be preferred to Pilates and postural education for CLBP.

Funding, acknowledgements: This study was not supported by any research foundation.

Keywords: Pain Neuroscience Education, Chronic Low Back Pain, Occupational Health

Topic: Pain & pain management

Did this work require ethics approval? Yes

Institution: University of Aveiro

Committee: Ethics and Deontology Council of Aveiro University

Ethics number: Nº21 – CED/2019, Registered in ClinicalTrials.gov - NCT04191317