PAIN NEUROSCIENCE EDUCATION IN NECK PAIN MANAGEMENT: A SYSTEMATIC REVIEW

Background

Neck pain is a worldwide public health problem, highly prevalent, and varies significantly between countries. It is one of the leading causes of disability in the world. It is estimated that half of the world's population will experience an episode of neck pain. On the other hand, compared to other conditions, the number of treatments dedicated to the management of neck pain is relatively low. In comparison with traditional biomechanical models, Pain Neuroscience Education (PNE) is a recent approach, providing the patient with a better understanding of pain and the sensation experienced by him. Considering the heterogeneous nature of each individual and its multidimensionality, it is necessary to use the PNE in a heterogeneous way based on the patient.

Objectives

The purpose of this study was to explore the effectiveness of PNE as a treatment approach for people suffering from chronic neck pain.

Methods

This is a systematic review prospectively registered in PROSPERO (CRD42021283000), following the PRISMA checklist and Cochrane recommendations. Titles and abstracts were screened by independent reviewers, the inclusion criteria were published in the English language, investigating the effects of PNE on neck pain in adult subjects. The third reviewer will resolve discrepancies between reviewers The analysis of the methodological quality of the eligible studies was performed using the PEDro quality scale. Data were analyzed and extracted using the PICO strategy. For data analysis, the GRADE system was considered. Outcome measures were described in a narrative form.

Results

2670 studies were identified; 54 were considered potentially relevant and 10 of these were read in full. Finally, five articles met the inclusion criteria. The included studies analyzed the effect of PNE on 516 participants, of which 350 (67.82%) were female and 166 (32.17%) were male. The mean age of patients ranged between 18 and 65 years. The content of the educational sessions included approaches on peripheral sensitization, central sensitization, biopsychosocial factors related to pain, catastrophic thoughts, understanding and accepting pain, coping with pain, catastrophic factors, emotional response to pain, anxiety, fear of harm, concerns/ fear of pain, goal setting, nociceptive inhibition and facilitation, participation in social contexts, pain neurophysiology, general nervous system physiology, coping strategies, stress management, and progressive return to activities. The five studies included in this review addressed the effectiveness of PNE by addressing pain-related issues. The methodological quality ranged from 6 (moderate quality) to 10 (high quality), with an average score of 7.4. The duration of the educational sessions ranged from 30 to 90 minutes, some held in groups and others individually.

Conclusion

The results of this review show that NDT is a promising intervention for neck pain; however, based on the GRADE evidence rating systems, the strength of evidence is low.

Implications

The authors of this review consider that many studies have neglected to characterize the educational intervention and have provided little information about the educational system used. Future research must be done with more rigorous attention to the methods employed.