Andias R, Sa-Couto P, Silva AG Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial. Phys Ther. 2022 Jun 3;102(6). pii: 6575293. doi: 10.1093/ptj/pzac048. (Original study)

OBJECTIVE: Pain neuroscience education (PNE) and exercise have emerged as potential interventions in adolescents with chronic pain; however, very few studies have explored their effectiveness. Blended-learning approaches combining face-to-face and online educational sessions have also emerged as facilitating methods of health education. This study aimed to compare the effectiveness of exercises and PNE versus exercise alone in adolescents with chronic neck pain (NP).

METHODS: A randomized controlled trial with 6-month follow-up was conducted in 2 high schools. Over 8 weeks, a total of 127 adolescents with chronic NP were randomly allocated to either (1) perform functional and region-specific exercises, including generalized neuromuscular control, endurance, and strength exercises, as well as exercises targeting the deep neck flexor and extensor muscles and scapular stabilizer muscles; or (2) perform the same exercise-based intervention plus PNE. Pain intensity (primary outcome), disability, sleep, catastrophizing, fear of movement, self-efficacy, and knowledge of pain neuroscience were assessed at baseline, postintervention, and 6-month follow-up. Neck and scapular muscle endurance and pressure pain thresholds were assessed at baseline and postintervention. Patient's Global Impression of Change was assessed postintervention and at 6-month follow-up.

RESULTS: There was a significant decrease in pain intensity from baseline to postintervention and from baseline to follow-up in both groups, but there were no between-group differences or interactions between time and groups. These results were similar for the secondary outcomes, except for knowledge of pain neuroscience, for which a significant group and time interaction was found.

CONCLUSION: Exercise and exercise plus PNE were similarly effective in treating adolescents with chronic NP, and the results were maintained for up to 6 months. Further studies are needed to explore the effect of these interventions for longer follow-ups.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

There was no control group and thus no conclusions can be made about the effectiveness of the interventions. Moreover, there is also a ceiling effect because exercise therapy is shown to be very effective in chronic neck pain. Thus, it is difficult to achieve a difference with additional treatment methods.

Rehab Clinician (OT/PT) rater

I would suggest that in future studies the researchers should consider measuring the impact of intervention on the academic performance and daily living activities of the students.

Rehab Clinician (OT/PT) rater

It is an interesting topic. However, since I work with an adult population, I would like to know if this applies to the adult population in the same way.

Rehab Clinician (OT/PT) rater

The important aspect of this study is that the additon of pain education to an exercise program did not result in any differences. The authors state, "Exercise and exercise plus PNE were similarly effective." This strictly speaking is true, but in the absence of a control or placebo group, the implication that either was effective is not supported by the study.
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