Cited by 537Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

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A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain

Moseley, G. Lorimer, Nicholas, Michael K., Hodges, Paul W.·2004·The Clinical Journal of Pain

DOI 10.1097/00002508-200409000-00007

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Abstract

OBJECTIVES: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. METHODS: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal "drawing-in" task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. RESULTS: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. DISCUSSION: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

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Psychosocial consequences of diagnosing nonspecific low-back pain radiologically: a qualitative study
Alhowimel, A., Alotaibi, M., Coulson, N., & Radford, K. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2020.1802799 · Cited by 12
“Although biopsychosocial evidence-based education is effective in reducing fear, anxiety, and disability in CLBP (Brox et al., 2008; Louw, Diener, Butler, and Puentedura, 2011; Moseley, 2002; Moseley, Nicholas, and Hodges, 2004), uncertainty about the given advice was noticed in our study.”
BackgroundResult
How manual therapy provided a gateway to a biopsychosocial management approach in an adult with chronic post-surgical low back pain: a case report
Toomey, D., Reid, D. A., & White, S. (2020) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2020.1813472 · Cited by 12
Does the Addition of Pain Neurophysiology Education to a Therapeutic Exercise Program Improve Physical Function in Women with Fibromyalgia Syndrome? Secondary Analysis of a Randomized Controlled Trial
Ceballos‐Laita, L., Mingo-Gómez, M. T., Estébanez-de-Miguel, E., Bueno-Gracía, E., Navas-Cámara, F. J., Verde, Z., Araque, A. F., & Jiménez‐del‐Barrio, S. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10112518 · Cited by 15
“PNE tries to normalize attitudes and behavior toward chronic pain using positive coping strategies in dealing with functionality-related complaints [39].”
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The EPIPHA-KNEE trial: Explaining Pain to target unhelpful pain beliefs to Increase PHysical Activity in KNEE osteoarthritis – a protocol for a multicentre, randomised controlled trial with clinical- and cost-effectiveness analysis
Stanton, T. R., BRAITHWAITE, F., Butler, D. S., Moseley, G. L., Hill, C. L., Milte, R., Ratcliffe, J., Maher, C. A., Tomkins‐Lane, C., Pulling, B. W., et al. (2021) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-021-04561-6 · Cited by 14
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Development of an interdisciplinary training program about chronic pain management with a cognitive behavioural approach for healthcare professionals: part of a hybrid effectiveness-implementation study
Munneke, W., Demoulin, C., Nijs, J., Morin, C., Kool, E., Berquin, A. D., Meeus, M., & Kooning, M. D. (2024) · BMC Medical Education · doi:10.1186/s12909-024-05308-2 · Cited by 11
Randomized study of the impact of a therapeutic education program on patients suffering from chronic low-back pain who are treated with transcutaneous electrical nerve stimulation
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Current Understanding of Pain Neurophysiology among Physiotherapists Practicing in Saudi Arabia
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Introducing the comprehensive pain management editorial series
Nijs, J., & Lahousse, A. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100506 · Cited by 13
Spouse and Patient Beliefs and Perceptions About Chronic Pain: Effects on Couple Interactions and Patient Pain Behavior
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“In contrast, other studies combining intensive in-person education with a workbook only noted improvements in pain catastrophizing [22].”
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ESSOMM European core curriculum and principles of manual medicine
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Louw, A., & Schmidt, S. G. (2015) · Journal of Manual & Manipulative Therapy · doi:10.1179/2042618615y.0000000006 · Cited by 10
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Multimodal Physiotherapy Based on a Biobehavioral Approach as a Treatment for Chronic Tension-Type Headache: A Case Report
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Schmerzmechanismen und Clinical Reasoning
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An eCoach-Pain for Patients with Chronic Musculoskeletal Pain in Interdisciplinary Primary Care: A Feasibility Study
Lamper, C., Huijnen, I. P. J., de Mooij, M. A. C., Köke, A. J. A., Verbunt, J., & Kroese, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111661 · Cited by 10
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Physiotherapeutic Rehabilitation Following Lumbar Total Disc Replacement: A Retrospective Study
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Knowledge translation from continuing education to physiotherapy practice in classifying patients with low back pain
Karvonen, E., Paatelma, M., Kesonen, J.-P., & Heinonen, A. O. (2014) · Journal of Manual & Manipulative Therapy · doi:10.1179/2042618614y.0000000091 · Cited by 9
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Method

Authors: Moseley, G. L., Nicholas, M. K., & Hodges, P. W.
Affiliations: The University of Sydney (AU)
Corresponding author: Moseley, G. Lorimer
Hodges, Paul W.
ORCID: Moseley, G. Lorimer
Nicholas, Michael K.
Hodges, Paul W.
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004
Volume: 20
Issue: 5
Pages: 324-330
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/00002508-200409000-00007
OpenAlex: W2078673653
Cited by: 537
References: 50
Citations by year: 2026: 16 · 2025: 23 · 2024: 36 · 2023: 32 · 2022: 24 · 2021: 50 · 2020: 45 · 2019: 31 · 2018: 34 · 2017: 31 · 2016: 40 · 2015: 34 · 2014: 18 · 2013: 20 · 2012: 16
FWCI: 2.30
Type: journal article
Language: en
Open access: closed
Locations: Clinical Journal of Pain (publishedVersion)
PubMed (publishedVersion)
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: neurophysiology education, chronic low back pain, pain-related cognitions, pain catastrophizing, pain attitudes, disability, physical performance, cognitive-behavioral pain management, physiotherapy education
MeSH terms: Adult, Analysis of Variance, Chronic Disease, Double-Blind Method, Female, Humans, Male, Middle Aged, Neurophysiology, Pain Measurement, Patient Education as Topic, Psychomotor Performance, Surveys and Questionnaires, Cognitive Behavioral Therapy, Low Back Pain

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A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain

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