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Cited by 272Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

The DOI matches its Crossref record; 37 of the 37 references it cites were found in a registry or an index.

Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial

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Malfliet, Anneleen, Kregel, Jeroen, Coppieters, Iris, De Pauw, Robby, Meeus, Mira, Roussel, Nathalie, Cagnie, Barbara, Danneels, Lieven, Nijs, Jo·2018·JAMA Neurology
DOI 10.1001/jamaneurol.2018.0492PMC PMC6145763
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Abstract

Importance: Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. Objective: To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Design, Setting, and Participants: Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Interventions: Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Main Outcomes and Measures: Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). Results: There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Conclusions and Relevance: Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. Trial Registration: clinicaltrials.gov Identifier: NCT02098005.

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  1. Fischer, 1990, Application of pressure algometry in manual medicine., J Manual Med, 5, 145
  2. Butler, 2003, Explain Pain

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Metadata

Authors
Malfliet, A., Kregel, J., Coppieters, I., De Pauw, R., Meeus, M., Roussel, N., Cagnie, B., Danneels, L., & Nijs, J.
Affiliations
  • Vrije Universiteit Brussel (BE)
  • Ghent University (BE)
  • Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
  • University of Antwerp (BE)
Corresponding author
Malfliet, Anneleen
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2018-07-01
Volume
75
Issue
7
Pages
808
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2018.0492
PMC
PMC6145763
OpenAlex
W2797034756
Cited by
272
References
37
Citations by year
2026: 21 · 2025: 30 · 2024: 56 · 2023: 43 · 2022: 32 · 2021: 33 · 2020: 29 · 2019: 25 · 2018: 3
FWCI
14.41
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • Fonds Wetenschappelijk Onderzoek
  • Vlaamse regering
Topics
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
Keywords
pain neuroscience education, chronic non-specific low back pain, chronic neck pain, central sensitization, pain-related cognitions, pressure pain threshold, pain-related disability, gray matter morphology, physiotherapy, exercise therapy, mental health, physical health, cognitive behavioral therapy, pain catastrophizing, fear avoidance
MeSH terms
Adult, Back Pain, Cognition, Exercise Therapy, Female, Humans, Male, Middle Aged, Neurosciences, Patient Education as Topic, Whiplash Injuries, Low Back Pain, Neck Pain, Physical Therapy Modalities, Failed Back Surgery Syndrome, Central Nervous System Sensitization, Chronic Pain, Gray Matter

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