Pain Neuroscience Education [PNE] on pain, disability, and kinesiophobia in patients with chronic low back pain: A systematic review.

To determine the effectiveness of pain neuroscience education on pain, disability, kinesiophobia in patients with Chronic low back pain.

This systematic review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. A computer-assisted database search was conducted for articles in Medline, Central, Embase, PEDro, CINAHL, SPORTDiscus, and Web of Science databases searched from August 2000 to March 2024. Randomized clinical trials that compared NPE with other physiotherapy interventions in the management of chronic LBP were included.

A total of 4672 articles were found from different databases. After screening and removing duplicates, nine studies met the inclusion and exclusion criteria. Critical Appraisal Skills Programme (CASP) was used to check the quality of the study. Out of 9 studies included, 6 were good and the remaining 3 were of moderate quality. Studies showed NPE group significant reduction in the intensity of the pain compared to the control. 2 studies included the Tampa Scale of Kinesio-phobia-11 (TSK-11) and were found to have a significant reduction of kinesiophobia.

Therefore, this review suggests that NPE combined with other interventions is effective in pain intensity, disability, and kinesiophobia in the management of patients with Chronic low back pain.

In our current clinical practice, as a part of multi-modal approach, we often include PNE in alignment with usual physiotherapy care such as exercise prescription, manual therapy while treating chronic back pain. 

With limited evidence, it is hard to distinguish which intervention format is more effective in the management of cLBP, therefore warrants the need for further research to determine clear differences in the interventions. PNE and physiotherapy effect on psychological aspects of patients showed potential improvements to kinesiophobia and catastrophisation but improvements were negligible failing to demonstrated clinically meaningful changes.