​Research has suggested that exercise is effective in the treatment of chronic low back pain (CLBP), regardless the characteristics of the exercise selected. Although it’s effective, exercise as intervention alone does not seem to take into consideration the maladaptive pain cognitions and illness behavioural characteristics frequently identified in CLBP patients. 

One of the strategies which can be used in order to change maladaptive pain cognitions, illness perceptions or coping strategies is the use of pain neurophysiology education. However, little is known about the real impact on the outcomes when adding pain neurophysiology education to exercise.

Thus, we conducted a randomized controlled trial in order to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in CLBP patients. Were included 62 patients who received aquatic exercise and pain neurophysiology education (n = 30) or aquatic exercise alone (n = 32). All participants performed a 6-week programme consisting of 12 sessions of aquatic exercise. Additionally, the education group received two group sessions of pain neurophysiology education (90-minute each) immediately before starting the aquatic exercise programme.

The results of our study show a trend for the education group to score better than the control group at the 6 weeks post-intervention and at the 3 months follow-up, however statistically significant differences between these groups were only found in pain intensity at the 3 months follow-up (mean SD change: –25.4± 26.7 vs –6.6 ± 30.7, p < 0.005). Additionally, immediately after the intervention approximately 60% of the participants of the education group perceived a clinically important improvement in pain intensity and functional disability compared to a percentage of approximately 40% in the control group. At 3 months follow-up the percentage of perceived benefit in functional disability increased to 72%, with statistically significant differences compared with the control group (RR=1.63, 95%CI: 1.01–2.63).

The reason why the education group had better medium term outcomes in this study is unclear. However, it is hypothesised that these outcomes may be related to the pain neurophysiology education component. Previous studies have found a positive and strong relationship between changes in maladaptive pain beliefs and the patient’s ability to perform physical tasks. Other research studies have also shown that pain reconceptualization reduces pressure pain threshold, pain catastrophizing and modifies maladaptive pain beliefs about the origin of pain. Those studies’ findings have also suggested that a better understanding of the pain condition could not only contribute to change maladaptive pain cognitions, but could also improve the patients’ perception of their ability to control and manage pain.

The authors 
Diogo Pires, MSc, PT  
Eduardo Brazete Cruz, PhD, PT 
Carmen Caeiro, PhD Student, PT

Further reading & reference:
http://www.ncbi.nlm.nih.gov/pubmed/25200879