Pain neuroscience education improves quality of life when added to aquatic exercise therapy for women with fibromyalgia: randomized controlled clinical trial

Abstract

Purpose

The aim of the present study was to investigate the effects of adding Pain Neuroscience Education (PNE) to an aquatic therapy protocol on pain, fibromyalgia (FMS) impact, quality of life and sleep.

Materials and Methods

Seventy-five women were randomly allocated into two groups: aquatic exercises (AEG, n = 36) and aquatic exercises + PNE (PNG, n = 39). The primary outcome was pain, and the secondary outcomes were FMS impact, quality of life, sleep and pain sensitivity (pressure pain thresholds – PPTs). Participants performed 45-min sessions of aquatic exercises, twice a week, for 12 weeks. PNG also received 4 PNE sessions during this period. Participants were assessed four times: initial (before treatment), after 6 weeks (intermediate) and 12 weeks (final) of treatment and after 12 weeks after the end of treatment (follow-up).

Results

Both groups improved pain after treatment, with no difference between them (p > 0.05, partial ƞ² 0.10). FMS impact and PPTs improved after treatment with no difference between groups, and sleep did not change. Quality of life improved several domains for both groups, with slightly better results for the PNG, with low effect sizes between groups.

Conclusions

The present results show that the addition of PNE to an aquatic exercise intervention did not provide larger effects than aquatic exercises alone for people with FMS concerning pain intensity, but provided benefit for health-related quality of life for this population.

Trial registration

ClinicalTrials.gov (NCT03073642, version 2, April 1^st, 2019).

Perspective

The addition of 4 Pain Neuroscience Education sessions to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome on pain, fibromyalgia impact, and sleep, but improved quality of life and pain sensitivity.

IMPLICATIONS FOR REHABILITATION

• Aquatic exercises are commonly prescribed, but patient education is crucial for the treatment.

• The addition of Pain Neuroscience Education to an aquatic exercises protocol did not add benefits for women with fibromyalgia syndrome.

• The positive changes on quality of life and pain sensitivity that this combination led to had small effect sizes and did not achieve minimal important clinical difference.

Keywords:

• Hydrotherapy
• health education
• physical therapy
• chronic pain
• rehabilitation

Ethical approval

Ethics Committee on Human Research of the Federal University of São Carlos (CAAE: 65119617.6.0000.5504, protocol number 1.974.700).

Prior Presentation

A part of this manuscript has been presented at the 17^th World Congress on Pain, held September 12–16^th, 2018, Boston, USA, with the title “Pain Neuroscience Education and hydrotherapy for fibromyalgia patients: preliminary results” and on the IASP 2021 Virtual Congress on Pain, held virtually June 9–11^th and 16–18^th 2021, with the title “Pain Neuroscience Education and Aquatic Exercises for people with fibromyalgia: randomized controlled clinical trial”.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was financed by São Paulo Research Foundation [FAPESP, grants 2017/03278-0, 2017/11521-2 and 2019/01278-9] and Coordination of Improvement of Higher Education Personnel - Brazil (CAPES) - Financing Code 001.