Pain neurophysiology education in conjunction with treatment interventions decreases chronic low back pain more than treatment interventions alone: a meta-analysis

Back pain has been ranked sixth in overall national medical costs1 and second most common reason Americans utilize physician visits.2 More than 30% of U.S. adults report experiencing back pain in the previous 3 months2,3 and approximately half of the 30% will develop chronic low back pain (CLBP), contributing to annual care expenses of $84.1-$624.8 billion. Current physical therapy practice guidelines for low back pain are varied and none address all pain that CLBP patients are suffering beyond normal tissue healing and are experiencing an abnormal increase in the body’s natural pain alarm system.7,13,17,18,30-37 Studies show that Pain Neurophysiology Education (PNE) can improve the pain alarm system making an important element that should be included in clinical practice guidelines.37-52 An electronic search was performed covering the years 2000-2017 from the following databases: CINAL, PubMed, and APTA JOSPT. The search strategy yielded 113 articles, after duplicates were removed, inclusion criteria and exclusion criteria met, 2 articles remained. The pain analysis demonstrated homogeneity (Q= 2.38, p= 0.34) of the articles64, had a low total variation (I2= 15.97%).65The overall effect size (d= -.21, 95% CI [-.53, .12]).64 The current biomedical education is not working, which is clearly reflected in the CLBP epidemic. PNE has shown to diminish psychosocial factors during medical visits20,31,54,55 and has a small effect on reducing CLBP, making it a logical substitution to the current biomedical education.