Effekte von präoperativer neurobiologischer Edukation auf das postoperative Outcome

Zusammenfassung Hintergrund Schmerz hat einen entscheidenden Einfluss auf die humane Lebensqualität. Allein eine Wissensvergrößerung über neurobiologische Vorgänge kann das subjektive Schmerzempfinden sowie psychometrische Variablen positiv beeinflussen. Es gibt verschiedene Formen der präoperativen Patientenedukation, welche u. a. zum Ziel haben, den postoperativen Schmerz zu erklären. Laut der aktuellen Literatur liegt einer präoperativen biomedizinischen Edukation eine geringe Evidenz zugrunde. Sie kann das präoperative Angst- und Stresslevel der Patienten steigern, was sich negativ auf das postoperative Outcome auswirkt. Im Gegensatz zur biomedizinischen Edukation betrachtet das neurobiologische Verständnis den postoperativen Schmerz unter den Gesichtspunkten der Plastizität des Nervensystems und bezieht Sensibilisierungsprozesse im zentralen und peripheren Nervensystem mit ein. Ziel Systematische Untersuchung von Kurz- und Langzeiteffekten einer neurobiologischen (Schmerz‑)Edukation bei Patienten vor einer Wirbelsäulenoperation Material und Methoden Bei der Literaturrecherche wurde nach dem PI(C)O(Population Intervention Comparison Outcome)‑Schema in den medizinischen Datenbanken gesucht. 83 Artikel kamen in die engere Auswahl. Entsprechend den Ein- und Ausschlusskriterien konnten letztendlich neun Artikel eingeschlossen werden. Ergebnisse Durch eine präoperative neurobiologische (Schmerz‑)Edukation können postoperative Katastrophisierungstendenzen sowie die postoperative Kinesiophobie positiv beeinflusst werden. Keinen Einfluss hat eine präoperative neurobiologische Edukation auf postoperativen Schmerz und Funktion. Inkonsistenz besteht bislang in der Herangehensweise der PNE (Pain Neuroscience Education). Schlussfolgerung Eine präoperative Reduktion von Angst und schmerzaufrechterhaltenden Faktoren v. a. auf psychologischer und sozialer Ebene hat einen positiven Effekt auf die postoperative subjektive Schmerzbewertung, was sich in einer Reduktion von Angst, Katastrophisierungstendenzen und einer geringeren Inanspruchnahme von postoperativen Leistungen im Gesundheitswesen widerspiegelt.

Pain Neuroscience Education for Depression: A Pilot Study

Objective: To determine if a brief, one-on-one pain neuroscience education (PNE) session delivered by a physical therapist (PT) can influence depression. Methods: A convenience sample of patients with persistent low back pain (LBP) (n = 23) attending PT with moderate to severe depression (Patient Health Questionnaire-9 [PHQ-9]) participated in the study. Patients received a standardized, one-on-one 30-minute PNE session by a PT with pre- and post-intervention measures of low back and leg pain (Numeric Pain Rating Scale [NPRS]), pain catastrophization (Pain Catastrophization Scale [PCS]), pain knowledge (Revised Neurophysiology of Pain Questionnaire [rNPQ] and depression (PHQ-9). Results: Immediately following PNE, all measures improved, with low back and leg pain not being significant (pback = 0.345 and pleg = 0.633), while pain catastrophization (p = 0.047), pain knowledge (p = 0.001) and depression (p = 0.004) reaching significant improvements. The PNE session shifted various patients to lower levels of depression, with 21.8% of the patients’ improvement in depression meeting or exceeding the minimal clinical important difference. Conclusion: PNE may be a safe, clinically effective way to help a subgroup of patients attending PT with depression. More studies are needed to further explore the results from this pilot study.

Instegating Pne In Patient Of Algophobic Chronic Low Back Pain

Chronic low back pain is the leading cause of disability and health care usage and is also a common condition requiring Physio therapeutic intervention. The most common symptom in musculoskeletal condition is pain. Pain which lasts for less than a 3 months is called as acute pain which last more is defined as chronic pain. Pain is a complex phenomenon involving both emotional and physical component. Current intervention and approaches are more physical component based which leads to treatment of just physical component. the emotional component usually leads to avoidance the avoidance can be because of fear of pain which is termed as algophobia Pain Neuroscience education is useful approaching treatment of emotional component of pain. pne approach includes explanation of pain using photos images videos or even verbally In this report a 65year-old female came with complaints of chronic low back pain for 6 months the p ain was present on the left side. Intervention used is pain neuroscience education to ­­chronic low back pain. The report represents the effectiveness of PNE with the conventional mode of treatment is useful in the treatment of chronic low back pain. The results demonstrated improvement in quality of life and reduced fear and catastrophization.

Additional effect of pain neuroscience education to craniocervical manual therapy and exercises for pain intensity and disability in temporomandibular disorders: a study protocol for a randomized controlled trial

The objective of this study will be to investigate the additional effect of pain neuroscience education program compared to a craniocervical manual therapy and exercises program for pain intensity and disability in patients with temporomandibular disorders (TMD). This study will be a randomized controlled trial comprising a sample of 148 participants. Subjects between 18 and 55 years, both genders, will undergo a screening process to confirm painful TMD by the Research Diagnostic Criteria (RDC/TMD), and then the volunteers will be randomized into two groups (G1: pain neuroscience education + craniocervical manual therapy and exercises vs. G2: craniocervical manual therapy and exercises). The volunteers will be recruited at the dentistry clinic. The intervention will be administered twice a week for 6 weeks by a single therapist lasting 1 h per session. The primary outcome will be pain intensity and disability and the secondary outcomes will be pain self-efficacy, kinesiophobia, and global perceived effect of improvement. The participants will be assessed immediately after the last session and at one- and three-month follow-ups. All statistical analyses will be conducted following intention-to-treat principles, and the treatment effects will be calculated using linear mixed models. The results of this study may contribute to understand the additional effect of pain neuroscience education intervention on TMD patients submitted to manual therapy and exercise. Trial registration ClinicalTrials.gov NCT03926767. Registered on April 29, 2019.

Physiotherapy combined with therapeutic neuroscience education versus physiotherapy alone for patients with chronic low back pain: A pilot, randomized-controlled trial

Objectives: The aim of this study was to investigate the effect of therapeutic neuroscience education (TNE) combined with physiotherapy on pain, kinesiophobia, endurance, and disability in chronic low back pain (CLBP) patients. Patients and methods: Between November 2016 and December 2017, a total of 31 patients with CLBP (5 males, 26 females; mean age: 42.3±10.8 years; range, 20 to 58 years) were randomly allocated to receive physiotherapy combined with TNE (experimental group, EG, n=16) and physiotherapy alone (control group, CG, n=15). All participants received physiotherapy consisting of five sessions per week for a total of three weeks. In addition to physiotherapy, the EG received TNE sessions consisting of two sessions per week for a total of three weeks. The primary outcomes were pain intensity as assessed by Visual Analog Scale (VAS) and kinesiophobia by Tampa Scale for Kinesiophobia (TSK), while and the secondary outcomes were trunk muscle endurance as assessed by the partial curl-up test (trunk flexor endurance [TFE]) and modified Sorensen test (trunk extensor endurance [TEE]) and disability by Roland-Morris Disability Questionnaire (RMDQ). Results: All patients completed the study. The median VAS, TSK, TFE, TEE, and RMDQ scores for the EG significantly improved after three weeks, while there was only significant improvement in the VAS, TSK, and RMDQ scores in the CG. The TSK decreased more in the EG than in the CG. The significant difference was evident in TSK and TFE in favor of the EG (p<0.05). Conclusion: These results suggest that the combination of TNE with physiotherapy can improve kinesiophobia and trunk flexor muscle endurance of patients with CLBP in the short-term.

Pain Neuroscience Education Combined with Therapeutic Exercises Provides Added Benefit in the Treatment of Chronic Neck Pain

Background: Chronic neck pain is common in the adult general population. Although the etiology of chronic neck pain is under debate, it is clear that chronic neck pain is multifactorial, with both physical and psychosocial contributors. Objective: To determine whether adding pain neuroscience education (PNE) to therapeutic exercises improved their pain–disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy in subjects with chronic nonspecific neck pain. Methods: This study was a three-arm randomized control trial. Seventy-two patients with chronic nonspecific neck pain were allocated to three groups: therapeutic exercises alone (n = 24), combined (therapeutic exercises + PNE; (n = 24), and a control group (n = 24). Each program took place three times a week, lasting for six weeks. The disability index, pain catastrophizing, fear–avoidance beliefs, and pain self-efficacy measured by the Neck Pain and Disability Scale (NPAD), Pain Catastrophizing Scale (PCS), Fear–Avoidance Beliefs Questionnaire (FABQ), and Pain Self-Efficacy Questionnaire (PSEQ), respectively. Participants were assessed before and after the six-week intervention, and there was no further follow-up. Results: For the outcomes NPAD, PSC, and FABQ, combined intervention demonstrated more significant improvements than therapeutic exercises alone (p ≤ 0.05), whereas no differences were observed between the two intervention groups for PSEQ (p = 0.99). In addition, significant differences were favoring experimental groups versus control for all outcomes (p ≤ 0.001). Conclusion: Therapeutic exercises combined with pain neuroscience education reduced the pain–disability index, pain catastrophizing, and fear–avoidance beliefs more than therapeutic exercises alone in patients with chronic neck pain. For pain self-efficacy, there was no statistically significant difference between the two intervention groups; however, the combined group had a more significant effect than therapeutic exercises alone. Further studies with longer periods and follow-up are required.