Effectiveness of Pain Neurophysiology Education on Musculoskeletal Pain: A Systematic Review and Meta-Analysis

OBJECTIVES: To estimate the effectiveness and safety of Pain Neurophysiology Education (PNE) on pain, disability, and psychological distress at post-intervention and long-term (closest to twelve months after initiating the intervention) in musculoskeletal pain (MSKP). METHODS: Randomized Controlled Trials (RCT) were identified in six engines, reference lists, ClinicalTrials.gov, and by contacting key researches. Risk of bias was assessed using Cochrane Collaboration Risk of Bias Tool 2.0. Meta-analyses, using Restricted Maximum Likelihood Method, were conducted to estimate standardized mean differences (SMD) and overall quality of evidence was evaluated according to GRADE. RESULTS: In total, 18 RCTs (n = 1,585) were included. There was small to moderate effects of PNE on pain at post-intervention and long-term: SMD = -0.32 (95% confidence interval [CI]: -.58; -.05) and SMD = -0.40 (95% CI: -.78; -.03), respectively. On disability, PNE had a small effect at post-intervention: SMD = -0.17 (95% CI: -.34; -.01) but was insignificant at long-term: SMD = -0.27 (95% CI: -.59; .06). Likewise, there was a small to moderate effect on psychological distress at post-intervention: SMD = -0.36 (95% CI: -.67; -.06) but was insignificant at long-term: SMD = -0.37 (95% CI: -.75; .01). Quality of evidence was low across all outcomes. Additional analyses showed significant effects of PNE, corresponding to moderate effects, on pain and psychological distress at both time points in chronic MSKP. CONCLUSIONS: Overall quality of evidence was low, supporting PNE being safe and having small to moderate effects on pain at both time points, and on disability as well as psychological distress at post-intervention.