Pain Neurophysiology Education and Therapeutic Exercise for Patients With Chronic Low Back Pain: A Single-Blind Randomized Controlled Trial

Arch Phys Med Rehabil. 2018 Feb;99(2):338-347. doi: 10.1016/j.apmr.2017.10.016. Epub 2017 Nov 11.


Objective: To assess the effect of a pain neurophysiology education (PNE) program plus therapeutic exercise (TE) for patients with chronic low back pain (CLBP).

Design: Single-blind randomized controlled trial.

Setting: Private clinic and university.

Participants: Patients with CLBP for ≥6 months (N=56).

Interventions: Participants were randomized to receive either a TE program consisting of motor control, stretching, and aerobic exercises (n=28) or the same TE program in addition to a PNE program (n=28), conducted in two 30- to 50-minute sessions in groups of 4 to 6 participants.

Main outcomes measures: The primary outcome was pain intensity rated on the numerical pain rating scale which was completed immediately after treatment and at 1- and 3-month follow-up. Secondary outcome measures were pressure pain threshold, finger-to-floor distance, Roland-Morris Disability Questionnaire, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, and Patient Global Impression of Change.

Results: At 3-month follow-up, a large change in pain intensity (numerical pain rating scale: -2.2; -2.93 to -1.28; P<.001; d=1.37) was observed for the PNE plus TE group, and a moderate effect size was observed for the secondary outcome measures.

Conclusions: Combining PNE with TE resulted in significantly better results for participants with CLBP, with a large effect size, compared with TE alone.

Keywords: Exercise therapy; Low back pain; Neuroscience; Rehabilitation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Chronic Pain / rehabilitation*
  • Disability Evaluation
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Low Back Pain / rehabilitation*
  • Male
  • Middle Aged
  • Neurophysiology / education*
  • Pain Measurement
  • Patient Education as Topic*
  • Quality of Life
  • Single-Blind Method
  • Treatment Outcome

Associated data

  • ANZCTR/ACTRN12617000097347