Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain

Objective To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP). Design Single-blind randomized controlled trial. Setting Private clinic and university. Participants Patients with CLBP for ≥6 months (N=56). Interventions Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants. Main Outcomes Measures The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change. Results At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: −2.2; −2.93 to −1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures. Conclusions Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone.