Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis

Joaquín Salazar-Méndez; Rodrigo Núñez-Cortés; Luis Suso-Martí; Ivana Leão Ribeiro; María Garrido-Castillo; José Gacitúa; Guillermo Mendez-Rebolledo; Carlos Cruz-Montecinos; Rubén López-Bueno; Joaquín Calatayud

doi:10.1016/j.neubiorev.2023.105328

Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis

Neurosci Biobehav Rev. 2023 Oct:153:105328. doi: 10.1016/j.neubiorev.2023.105328. Epub 2023 Jul 27.

Affiliations

¹ Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile.
² Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile. Electronic address: r_nunez@uchile.cl.
³ Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain.
⁴ Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile.
⁵ Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Talca, Chile; Laboratorio de Investigación Somatosensorial y Motora, Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Chile.
⁶ Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile.
⁷ Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain.
⁸ Exercise Intervention for Health Research Group (EXINH-RG), Department Cf Physiotherapy, University of Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark.

PMID: 37516218
DOI: 10.1016/j.neubiorev.2023.105328

Abstract

The aim was to examine the moderator effect of duration of PNE (total minutes) on changes in psychosocial variables after treatment in people with chronic musculoskeletal pain. PubMed/MEDLINE, Embase, Web of Science, Scopus and CINHAL databases were systematically searched from inception to 6 February 2023. A mixed-effects meta-regression was performed to determine the moderator effect of PNE duration. Twenty-three studies involving 2352 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain neurophysiology knowledge, anxiety symptoms, catastrophizing and kinesiophobia. The total duration of PNE ranged from 40 to 720 min. A linear relationship was observed between longer duration of PNE (total minutes) and changes of psychosocial variables. In addition, a dose of 100, 200 and 400 min of PNE was estimated to exceed the minimum clinically important difference described in the literature for kinesiophobia (mean difference = -8.53 points), anxiety symptoms (mean difference = -1.88 points) and catastrophizing (mean difference = -7.17 points). Clinicians should provide a more tailored PNE to address psychosocial variables.

Keywords: Musculoskeletal disorders; Neurophysiology; Neuroscience; Pain; Patient education; Therapeutic education.

Publication types

Review