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Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial

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Randomized Controlled Trial

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Structural and chiropractic

Braz J Phys Ther. 2023 Sep-Oct;27(5):100555. doi: 10.1016/j.bjpt.2023.100555. Epub 2023 Oct 13.

Authors:

Fernando Augusto Gonçalves Tavares, João Vitor Alves Rossiter, Gabriela Caroline Leandro Lima, Letícia Gomes de Oliveira, Witor Souza Cavalcante, Mariana Arias Ávila, Steven Zachary George, Thais Cristina Chaves

Abstract.

Background: Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect. Objectives: To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP). Method: One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days). Results: No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = -0.90 [95% CI= -1.76, -0.4] and change baseline to 180 day follow-up = -1.19 [95% CI= -2.06, -0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up). Conclusion: The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy. Keywords: Chronic low back pain; Disability; Pain intensity; Pain neuroscience education; Spinal manipulative therapy.

Publication Date: 

2023 Sep-Oct

OEID: 

7143

Tavares, GAF., Rossiter, AVJ., Lima, LCG., Oliveira, dGL., Cavalcante, SW., Ávila, AM., George, ZS., Chaves, CT. (2023) 'Additional effect of pain neuroscience education to spinal manipulative therapy on pain and disability for patients with chronic low back pain: a randomized controlled trial', Braz J Phys Ther. 2023 Sep-Oct;27(5):100555. doi: 10.1016/j.bjpt.2023.100555. Epub 2023 Oct 13.

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