Immediate effect of pain neuroscience education for recent onset low back pain: an exploratory single arm trial

ABSTRACT

Study Design: A prospective, single-arm, pre-postintervention study.

Objective: To determine the preliminary usefulness of providing pain neuroscience education (PNE) on improving pain and movement in patients presenting with non-chronic mechanical low back pain (LBP).

Background: PNE has been shown to be an effective intervention for the treatment of chronic LBP but its usefulness in patients with non-chronic LBP has not been examined.

Methods: A single group cohort pilot study was conducted. Eighty consecutive patients with LBP < 3 months completed a demographics questionnaire, leg and LBP rating (Numeric Pain Rating Scale – NPRS), disability (Oswestry Disability Index), fear-avoidance (Fear-Avoidance Beliefs Questionnaire), pain catastrophizing (Pain Catastrophizing Scale), central sensitization (Central Sensitization Inventory), pain knowledge (Revised Neurophysiology of Pain Questionnaire), risk assessment (Keele STarT Back Screening Tool), active trunk flexion and straight leg raise (SLR). Patients received a 15-minute verbal, one-on-one PNE session, followed by repeat measurement of LBP and leg pain (NPRS), trunk flexion and SLR.

Results: Immediately after intervention, LBP and leg pain improved significantly (p < 0.001), but the mean change did not exceed minimal clinically important difference (MCID) of 2.0. Active trunk flexion significantly improved (p < 0.001), with the mean improvement (4.7 cm) exceeding minimal detectible change (MDC). SLR improved significantly (p = 0.002), but mean change did not exceed MDC.

Conclusions: PNE may be an interesting option in the treatment of patients with non-chronic mechanical LBP. The present pilot study provides the rationale for studying larger groups of patients in controlled studies over longer periods of time.

KEYWORDS:

• Low back pain
• sub-grouping
• pain neuroscience education
• clinical prediction rules

Disclosure statement

The authors Adriaan Louw, PT, PhD and Emilio Puentedura. PT, PhD, acknowledge receiving payment for various speaking events (seminars, conferences, etc.) as well as royalties from books, from professionals and patients. None of these conflicts influence the subject matter or materials discussed in this manuscript.

Ethical approval

The study was approved by the Internal Review Board (IRB) at St. Ambrose University, Davenport, IA.

Additional information

Funding

None to report

Notes on contributors

Adriaan Louw

Adriaan Louw, PT, PhD, CSMT is co-founder and CEO of International Spine and Pain Institute and guest lecturer/adjunct faculty at St. Ambrose University. He has a certificate in spinal manual therapy and has presented at numerous national and international manual therapy, pain science and medical conferences, and has authored and co-authored articles, books and book chapters related to spinal disorders and pain science.

Kevin Farrell

Kevin Farrell, PT, PhD, OCS, FAAOMPT is a professor in the Physical Therapy Department and serves as Chair of the Clinical Residency program in Orthopaedic Physical Therapy at St. Ambrose University. He is a board certified orthopaedic clinical specialist and a Fellow in the American Academy of Orthopaedic Manual Physical Therapists.

Breanna Choffin

Breanna Choffin, PT, DPT, OCS, CMT is staff physical therapist at Vanderbilt University in Nashville, TN. She is graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Brooke Foster

Brooke Foster, PT, DPT, OCS, CMT is staff physical therapist at Genesis Rehab in Silvis, IL. She is graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Grace Lunde

Grace Lunde, PT, DPT, OCS, CMT is staff physical therapist at Genesis Rehab in Davenport, IA. She is graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Michelle Snodgrass

Michelle Snodgrass, PT, DPT, OCS, CMT is staff physical therapist at Rock Valley Physical Therapy in Geneseo, IL. She is graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Robert Sweet

Robert Sweet, PT, DPT, OCS, CMT is staff physical therapist at Edward Elmhurst Health in Naperville, IL. He is graduate of Southwest Baptist DPT program and the St. Ambrose University residency program. He is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Matthew Weitzel

Matthew Weitzel, PT, DPT, OCS, CMT is staff physical therapist at Rock Valley Physical Therapy in Davenport, IA. He is graduate of St. Ambrose University DPT and residency programs.  He is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Rebecca Wilder

Rebecca Wilder, PT, DPT, OCS, CMT is staff physical therapist at Genesis Rehab in Moline, IL. She is graduate of St. Ambrose University DPT and residency programs. She is a board certified orthopaedic clinical specialist and has a certificate in manual therapy.

Emilio J. Puentedura

Emilio J. Puentedura, PT, DPT, PhD, OCS, CSMT, FAAOMPT is a professor in the Doctor of Physical Therapy Program at Baylor University. He is a board certified orthopaedic clinical specialist, a Fellow in the American Academy of Orthopaedic Manual Physical Therapists, and has a certificate in spinal manual therapy.