Table 1.
Characteristics of the included studies.
| Study | Studies k (n) Types | Meta-Analysis (k) | Population | Intervention | Control | Outcomes | Results and author’s conclusions |
|---|---|---|---|---|---|---|---|
| Overall chronic musculoskeletal pain | |||||||
| Watson et al. (2019) | 17 (15867) RCT | Yes (8) | Chronic musculoskeletal pain | PNE traditional physical therapy (manual therapy, exercise therapy) | Traditional physical therapy (manual therapy, exercise therapy) and nonactive interventions, minimal interventions (e.g., relaxation, breathing, or educational advice) |
|
The meta-analyzed pooled treatment effects for PNE versus control had low clinical relevance in the short term for pain and disability and in the medium term for pain and disability The treatment effect of PNE for kinesiophobia was clinically relevant in the short term and for pain catastrophizing in the medium term. Low certainty evidence. |
| Siddall et al. (2022) | 5 (263) RCT | Yes (5) | Chronic musculoskeletal pain | PNE combined with an exercise program. | Exercise program alone |
|
Meta-analysis revealed a significant difference in pain (WMD, 22.09; low certainty), disability (SMD, 20.68; low certainty), kinesiophobia (SMD, 21.20; moderate certainty), and pain catastrophizing (WMD, 27.72; very low certainty) that favored the combination of PNE and exercise. These findings suggest that combining PNE and exercise in the management of chronic musculoskeletal pain results in greater short-term improvements in pain, disability, kinesiophobia, and pain catastrophizing relative to exercise alone. |
| Marris et al. (2021) | 14 (1024) RCT | Yes (8) | Chronic musculoskeletal pain | PNE + traditional physical therapy. Session schedules varied across studies ranging from 1–2 sessions over 4–12 weeks. |
|
|
PNE in addition to traditional physical therapy interventions was more effective than traditional physical therapy only, wait-list, or medical management control groups. Meta-analysis results show statistically significant changes in both short and long-term pain and disability with a large effect for both short-term pain intensity and long-term disability. Certainty of evidence N/A. |
| Romm et al. (2021) | 18 (1982) RCT | Yes (8) | Chronic musculoskeletal pain | PNE as a part of intervention | Nonintervention, education, exercise therapy or multimodal physiotherapy |
|
Significant effects of PNE were found on all the outcome measures [pain intensity −0.85 (0.30); disability −0.48 (0.30); kinesiophobia −1.71 (0.36); catastrophizing −0.72 (0.20)]. Certainty of evidence N/A. |
| Cuenda-gago and Espejo-antúnez (2017) | 10 (793) RCT | No | Chronic musculoskeletal pain | PNE in isolation or combination with traditional physical therapy (manual therapy, exercise therapy) | Traditional physical therapy (manual therapy, exercise therapy) |
|
PNE alone is effective alone is effective in the short term for the relief of catastrophic pain from catastrophic pain due to erroneous beliefs and attitudes about pain. When PNE is combined with multimodal physiotherapy treatments, it appears that benefits in primary variables (pain and disability) and in some secondary variables (knowledge neurophysiology of pain, catastrophism, pain beliefs and cognitions, kinesiophobia beliefs and cognitions of pain, kinesiophobia, quality of life or life or algometry) are increased. Certainty of evidence N/A. |
| Kim and Lee (2020) | 8 (369) RCT | Yes (8) | Chronic musculoskeletal pain | PNE | Completely different interventions were performed or compared with other educational programs |
|
Meta-analysis results showed statistically significant results in favor to PNE compared with control group in pain and kinesiophobia. It was found that PNE alone was more effective when combined with trigger point dry needling and manual therapy. In addition, regardless of therapeutic intensity, a single session alone showed significant improvement, and indirect online education rather than direct education also showed significant improvement. Certainty of evidence N/A. |
| Louw et al. (2011) | 8 (401) RCT | No | Chronic musculoskeletal pain | PNE in isolation or combination with physical therapy | Another treatment, no treatment, or “usual” treatment. |
|
The results of this systematic review show compelling evidence for PNE affecting passive and active physical movements. Positive effects of PNE on pain perception, disability, and catastrophizing may allow patients to apply this new view of their pain state by reappraising their ability to move. Certainty of evidence N/A. |
| Bülow et al. (2021) | 15 (951) RCT | Yes (18) | Chronic musculoskeletal pain | PNE | Conventional therapy or treatment. |
|
In chronic musculoskeletal pain, the effects of PNE were moderate and statistically significant on pain intensity and psychological distress at short and long term. Low certainty evidence. However, the effects of PNE on overall were rather small, ranging from −0.93 to −1.16 and − 0.66 to −1.04 for pain intensity and disability on a 0–10 scale. |
| Louw et al. (2016) | 13 (734) RCT | No | Chronic musculoskeletal pain | PNE in isolation or combination with physical therapy | Another treatment, no treatment, or “usual” treatment. |
|
Strong evidence supports the use of PNE for in reducing pain ratings, limited knowledge of pain, disability, pain catastrophizing, fear-avoidance, unhealthy attitudes, and behaviors regarding pain, limited physical movement and healthcare utilization. Certainty of evidence N/A. |
| Chronic spinal pain | |||||||
| Bonatesta et al. (2021) | 8 (622) RCT | Yes (5) | Chronic Nonspecific Spinal Pain. | PNE + exercise therapy | Nonintervention, education, exercise therapy or multimodal physiotherapy |
|
There is low to very-low certainty of the evidence suggesting that PNE plus exercise therapy reduces pain, disability, kinesiophobia, and catastrophizing compared to exercise therapy or multimodal physiotherapy at short- and intermediate-term. |
| Wood and Hendrick (2019) | 8 (6761) RCT | Yes (6) | Chronic low back pain | PNE + exercise therapy, manual therapy, acupuncture, or dry needling | Waitlist controls, physiotherapy, other educational methods, or no treatment. |
|
Meta-analysis for short- term pain (n = 428) demonstrated a WMD of 0.73 (95%CI −0.14; 1.61) on a ten-point scale of PNE against no PNE (low certainty evidence). Short-term disability (RMDQ) meta-analysis demonstrated a WMD of 0.42 (moderate certainty evidence); whereas the addition of PNE to physiotherapy interventions demonstrated a WMD of 3.94 (moderate certainty evidence). |
| Clarke et al. (2011) | 2 (122) RCT | No | Chronic Low Back Pain | PNE | Anatomical education |
|
PNE is a promising intervention for the primary outcome measures of pain, physical-function, psychological- function and social-function. Very low certainty evidence. |
| Tegner et al. (2018) | 7 (1152) RCT | Yes | Chronic Low Back Pain | PNE | No intervention or usual care |
|
Statistically significant differences in pain, in favor of PNE, were found after treatment, WMD = −1.03 and after 3 months, WMD = −1.09. There was moderate evidence supporting the hypothesis that NPE has a small to moderate effect on pain and low evidence of a small to moderate effect on disability immediately after the intervention. PNE has a small to moderate effect on pain and disability at 3 months follow-up in patients with CLBP |
| Osteoarthritis | |||||||
| Ordoñez-Mora et al. (2022) | 4 (288) RCT and QE | No | Osteoarthritis | PNE | Conventional therapy or treatment. |
|
Non-pharmacological and educational interventions should be carried out within the interventional processes in patients with pain. The findings revealed an improvement in the groups managed with PNE, finding a small effect in favor of the interventions for variables such as kinesiophobia, with no changes observed in the other variables evaluated. Certainty of evidence N/A. |
| Fibromyalgia | |||||||
| Suso-Martí et al. (2022) | 8 (871) RCT | Yes | Fibromyalgia | PNE | Nonactive interventions, minimal interventions (e.g., relaxation, breathing, or educational advice), or no intervention. If any other treatment (such as medication or manual therapy) was included, it had to be applied in the intervention group as well. |
|
Meta-analysis showed statistically significant differences in pain intensity with a moderate clinical effect in seven studies at the post-intervention assessment (SMD: −0.76) but it did not show statistically significant differences in fibromyalgia impact, anxiety, and pain catastrophizing. There is low-certainty evidence that in patients with fibromyalgia, PNE can decrease the pain intensity in the post-intervention period and the fibromyalgia impact in the follow-up period. However, it appears that PNE showed no effect on anxiety and pain catastrophizing. |
| Saracoglu et al. (2022) | 4 (274) RCT | Yes (4) | Fibromyalgia | Multimodal approach including PNE (basic patient education about FM, exercise therapy, cognitive behavioral therapy, mindfulness training and pharmaco- logical treatment) | Treatment as usual, including basic patient education about the disease, recommendations on aerobic exercise, and pharmacological treatment and therapeutic exercise. |
|
The meta-analysis showed that PNE groups were statistically more effective on severity of FM (standard mean difference [SMD] = −1.051), pain intensity (SMD = −1.049), catastrophizing (SMD = −0.893), depression (SMD = −0.686) and anxiety (SMD = −0.711). This review demonstrates that adding PNE to a multimodal treatment including exercise therapy might be an effective approach for improving functional status, pain-related symptoms, anxiety, and depression for patients with FM. |
CLBP, Chronic Low Back Pain; PNE, Pain Neuroscience Education; RCT, Randomized Control Trial; QE, Quasi-experimental; SMD, Standardized Mean Difference; WMD, Weighted Mean Difference.