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Cited by 100Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

Blended-learning pain neuroscience education for people with chronic spinal pain: Randomized controlled multicenter trial

Open access
Malfliet, Anneleen, Kregel, Jeroen, Meeus, Mira, Roussel, Nathalie, Danneels, Lieven, Cagnie, Barbara, Dolphens, Mieke, Nijs, Jo·2018·Physical Therapy
DOI 10.1093/ptj/pzx092
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Abstract

Background: Available evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated. Objective: The study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions. Design: This study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked). Setting: The study took place at university hospitals in Ghent and Brussels, Belgium. Participants: Participants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain). Intervention: The intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology). Measurements: Measurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire). Results: None of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86). Limitations: Effect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies. Conclusions: Blended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.

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  • Adding a cognition-targeted active approach to pain science is considered critical in achieving larger long-term therapy effects, given that pain science as a stand-alone treatment only demonstrates small to medium effect sizes.

    “Indeed, adding a cognition-targeted active approach to pain science (e.g., progression to the next phase of education is preceded by an intermediate phase of imagery or work on cognitions that might hinder progression) is considered critical in achieving larger long-term therapy effects, given that pain science as a stand-alone treatment only demonstrates small to medium effect sizes [62,63].”

    From Best-evidence for the rehabilitation of chronic pain part 1: Pediatric pain (2019) · cites this paper as [62]

    The Abstract and Strengths, Limitations, and Recommendations for Further Research section (page unavailable) report small-to-moderate effects of pain neuroscience education and recommend combining it with other treatments. The paper does not establish that the specific cognition-targeted intermediate approach described in the citing sentence is critical for larger long-term effects; it calls for long-term follow-up to investigate whether benefits persist. (LLM, conf=0.87)

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Research works printed but not linked: 2

  1. Schulz KF, Altman DG, Moher D. CON- SORT 2010 statement: updated guide- lines for reporting parallel group ran- domised trials. BMC Med. 2010;8:18.
  2. Goubert L, Crombez G, Van Damme S, Vlaeyen J, Bijttebier P, Roelofs J. Con- firmatory factor analysis of the Tam- pa Scale for Kinesiophobia: invariant two-factor model across low back pain patients with fibromyalgia patients. Clin J Pain. 2004;20:103-110.

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Authors
Malfliet, A., Kregel, J., Meeus, M., Roussel, N., Danneels, L., Cagnie, B., Dolphens, M., & Nijs, J.
Affiliations
  • Vrije Universiteit Brussel (BE)
  • Ghent University (BE)
  • University of Antwerp (BE)
Corresponding author
Malfliet, Anneleen
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2017-09-01
Volume
98
Issue
5
Pages
357-368
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.1093/ptj/pzx092
OpenAlex
W2753185763
Cited by
100
References
69
Citations by year
2026: 11 · 2025: 9 · 2024: 14 · 2023: 14 · 2022: 9 · 2021: 21 · 2020: 13 · 2019: 5 · 2018: 4
FWCI
4.20
Type
journal article
Language
en
Open access
Locations
  • Physical Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
  • VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders
  • Fonds Wetenschappelijk Onderzoek (130246)
  • Vlaamse regering
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
  • Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords
pain neuroscience education, blended learning, chronic spinal pain, chronic neck pain, low back pain, kinesiophobia, pain catastrophizing, illness perception, disability, online learning
MeSH terms
Adult, Aged, Back Pain, Belgium, Disability Evaluation, Exercise Therapy, Female, Humans, Male, Middle Aged, Neurosciences, Pain Measurement, Patient Education as Topic, Surveys and Questionnaires, Treatment Outcome, Neck Pain, Catastrophization, Chronic Pain, Pain Management

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