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Kohns DJ, Urbanik CP, Geisser ME, et al. The Effects of a Pain Psychology and Neuroscience Self-Evaluation Internet Intervention: A Randomized Controlled Trial. Clin J Pain. 2020 Sep;36(9):683-692. doi: 10.1097/AJP.0000000000000857. (Original study)
Abstract

OBJECTIVES: Many patients' chronic musculoskeletal pain is strongly influenced by central nervous system processes such as sensitization or amplification. Education about pain neuroscience can change patients' beliefs but has less consistent effects on pain outcomes. Patients may have greater clinical benefits if the educational intervention is personalized, and they evaluate various psychosocial risk factors with respect to their pain. We developed and tested a brief, internet-based Pain Psychology and Neuroscience (PPN) self-evaluation intervention.

MATERIALS AND METHODS: From a patient registry, 104 adults reporting chronic musculoskeletal pain were randomized to the PPN intervention or a matched, active, education control condition. At baseline and 1-month (primary endpoint) and 10-month follow-ups, participants reported pain severity (primary outcome) and multiple secondary outcomes. Primary analyses compared the 2 experimental conditions using analyses of covariances; post hoc exploratory analyses compared the effects of PPN in subgroups of patients who met criteria for fibromyalgia (FM; n=50) or who did not (n=54; primarily spinal pain).

RESULTS: At 1-month follow-up, compared with the control condition, PPN led to significantly lower pain severity (?p =0.05) and interference (?p =0.04), greater brain (?p =0.07) and psychological (?p =0.07) attributions for pain, and greater readiness for pain self-management (?p =0.08). Effects on distress, pain catastrophizing, kinesiophobia, and life satisfaction were not significant. Exploratory analyses showed that the PPN intervention was especially beneficial for patients without FM but was of less benefit for those with FM. Most of the effects (except attributions) were lost at 10 months.

DISCUSSION: A brief PPN self-evaluation intervention, presented on-line, can yield short-term improvements in musculoskeletal pain severity and interference, especially for people with spinal/localized pain rather than FM, perhaps because the psychology/neuroscience perspective is more novel for such patients.

Ratings
Discipline Area Score
Psychologist 6 / 7
Physician 4 / 7
Comments from MORE raters

Physician rater

This is a randomised controlled trial of an internet based pain psychology and neuroscience self evaluation intervention which was studied in two patient groups, one diagnosed with fibromyalgia and one group which did not include fibromyalgia patients and were mainly spinal pain. Follow up was at 1 and 10 months with pain severity as the primary outcome and multiple secondary outcomes. At 1 month, there was significantly lower pain severity, pain interference, greater brain and psychological attributions for pain and greater readiness for pain self evaluation but other outcomes were not significantly different when compared to the matched active education control group. The intervention was more beneficial in the non fibromyalgia patient group and any benefits were largely lost by the 10 month follow up. It is unclear whether such an intervention really has a role in pain management but it clearly is mainly of benefit in certain patient groups rather in general.

Physician rater

This is an interesting article showing a modest short-term reduction in pain from an online self-help intervention.

Physician rater

This is an interesting concept, but the fact that effect doesn't last long makes it of limited use for primary care physicians.
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