Background

Spinal manipulative therapy (SMT) demonstrates small effects on pain intensity in low back pain. Combining SMT with a psychosocial intervention like pain neuroscience education (PNE) could promote additional effect.

Objectives

To evaluate the additional effect of PNE when combined to SMT on pain intensity and low back pain-related disability in patients with chronic low back pain (CLBP).

Method

One hundred and four patients with CLBP of both sexes aged between 18 and 55 years were treated with PNE + SMT compared to SMT alone. The primary outcome measures were pain intensity and disability post-treatment (4 weeks). Secondary outcomes were fear-avoidance beliefs, global perceived effect of improvement, and pain self-efficacy. Results were obtained immediately post-treatment and at three follow-ups (30-days, 90-days, and 180-days).

Results

No significant between-group difference was observed for pain intensity and disability post-treatment. In contrast, our results showed a significantly longer additional effect for the group treated with SMT + PNE for the following outcomes: pain intensity (change baseline to 90 day follow-up = −0.90 [95% CI= −1.76, −0.4] and change baseline to 180 day follow-up = −1.19 [95% CI= −2.06, −0.32]) and low back pain-related disability, global perceived effect of improvement and pain self-efficacy (180th day follow-up).

Conclusion

The results of this trial suggest the addition of PNE to SMT did not bring any additional effect on pain intensity and disability in the short term, but SMT + PNE can result in longer-lasting effects in patients with CLBP and that such an effect could be related to a possible mediator effect of pain self-efficacy.

中文翻译：

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疼痛神经科学教育对脊柱手法治疗对慢性腰痛患者疼痛和残疾的额外影响：一项随机对照试验

背景

脊柱手法治疗 (SMT) 对腰痛的疼痛强度影响很小。将 SMT 与疼痛神经科学教育 (PNE) 等心理社会干预措施相结合可以促进额外效果。

目标

旨在评估 PNE 与 SMT 联合使用对慢性腰痛 (CLBP) 患者的疼痛强度和腰痛相关残疾的额外影响。

方法

与单独 SMT 相比，104 名年龄在 18 至 55 岁之间的男女 CLBP 患者接受了 PNE + SMT 治疗。主要结局指标是治疗后（4 周）的疼痛强度和残疾。次要结果是回避恐惧的信念、整体感知的改善效果和疼痛自我效能。结果在治疗后立即和三次随访（30 天、90 天和 180 天）时获得。

结果

治疗后疼痛强度和残疾没有观察到显着的组间差异。相比之下，我们的结果显示，SMT + PNE 治疗组在以下结果方面具有明显更长的额外效果：疼痛强度（将基线更改为 90 天随访 = -0.90 [95% CI= -1.76, -0.4] 和将基线更改为 180 天随访 = −1.19 [95% CI= −2.06, −0.32]）以及腰痛相关残疾、改善的总体感知效果和疼痛自我效能（第 180 天随访）。

结论

该试验的结果表明，在 SMT 的基础上添加 PNE 短期内不会对疼痛强度和残疾产生任何额外影响，但 SMT + PNE 可以对 CLBP 患者产生更持久的影响，并且这种影响可能是与疼痛自我效能的可能中介效应有关。