OBJECTIVE: To evaluate the efficacy of a brief, structured pain neuroscience education (PNE) program on executive function and pain intensity in women with fibromyalgia (FM).
DESIGN: Randomized clinical trial.
SETTING: Rheumatology and pain clinics in Mexico and Colombia.
PARTICIPANTS: Sixty-two women aged 40-60 years diagnosed with FM according to American College of Rheumatology 2010 criteria.
INTERVENTIONS: Participants were randomly divided to either PNE plus usual care or usual care alone. The intervention consisted of ten 40-45-minute online PNE sessions delivered over 5 weeks.
MAIN OUTCOME MEASURES: Coprimary outcomes were pain intensity, assessed with the visual analog scale; FM impact, assessed with the Fibromyalgia Impact Questionnaire-Revised; and executive function (multidimensional domain), assessed with 4 tasks: the Wisconsin Card Sorting Test (cognitive flexibility), the Simon Task (inhibition), the Corsi Block-Tapping Task (visuospatial working-memory capacity), and the Digit Span Forward Task (phonological working-memory capacity). Secondary outcomes were central sensitization (Central Sensitization Inventory), pain catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-11), depressive symptoms (Beck Depression Inventory-II), and anxiety (State-Trait Anxiety Inventory).
RESULTS: Compared with controls, the PNE group showed greater reductions in pain (-3.24; P=.001), FM impact (-15.14; P=.001), central sensitization (-22.36; P=.001), catastrophizing (-7.24; P=.020), and kinesiophobia (-8.68; P=.001). Depressive symptoms also improved (-6.78; P=.023). Trait anxiety decreased more in the control group (P=.001). Executive-function effects were domain specific: phonological working memory (Digit Span Forward) improved significantly (P=.007), whereas no significant effects were observed for visuospatial working memory, cognitive flexibility, or inhibition after multiplicity adjustment.
CONCLUSION: PNE plus usual care significantly improves pain, functional impact, central sensitization, catastrophizing, kinesiophobia, and phonological working memory in FM. Cognitive effects were selective (no improvement in flexibility, inhibition, or visuospatial working memory) and mood outcomes were mixed.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The fact that this brief online Pain Neuroscience Education program suggests a clinically significant segmental benefit in fibromyalgia (FM) indicates that multimodal interventions should be considered.
Physician rater
This selective trial (75% screening failure!) has shown that a pain neuroscience approach can be helpful for treating widespread pain. However, we know that multiple education and counselling modalities can all be useful and it's unclear if this is better than others. The trial reinforces that education resources on understanding and managing widespread pain are important and should be provided to all.
, McMaster University