Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial

Thomas Bilterys; Jeroen Kregel; Jo Nijs; Mira Meeus; Lieven Danneels; Barbara Cagnie; Eveline Van Looveren; Anneleen Malfliet

doi:10.1016/j.msksp.2021.102494

Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial

Musculoskelet Sci Pract. 2022 Feb:57:102494. doi: 10.1016/j.msksp.2021.102494. Epub 2021 Dec 15.

Authors

Thomas Bilterys¹, Jeroen Kregel², Jo Nijs³, Mira Meeus⁴, Lieven Danneels⁵, Barbara Cagnie⁵, Eveline Van Looveren¹, Anneleen Malfliet⁶

Affiliations

¹ Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
² Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
³ Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
⁴ Pain in Motion International Research Group, Belgium(1); Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium; Department of Rehabilitation Sciences and Physiotherapy (MOVANT), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
⁵ Department of Rehabilitation Sciences, Faculty of Medicine & Health Sciences, Ghent University, Ghent, Belgium.
⁶ Pain in Motion International Research Group, Belgium(1); Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium; Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium. Electronic address: anneleen.malfliet@vub.be.

PMID: 34953290
DOI: 10.1016/j.msksp.2021.102494

Abstract

Background: Current evidence supports the use of pain neuroscience education (PNE) in several chronic pain populations. However, the effects of PNE at group level are rather small and little is known about the influence of personal factors (e.g. level of education [LoE]).

Objective: To examine whether the effectiveness of PNE differs in chronic spinal pain (CSP) patients with high LOE (at least a Bachelor's degree) versus lower educated patients.

Method: A total of 120 Belgian CSP patients were randomly assigned to the experimental (PNE) or control group (biomedical-focused neck/back school). Participants within each group were further subcategorized based on highest achieved LoE. ANOVA and Bonferroni post-hoc analyses were used to evaluate differences in effectiveness of the interventions between higher and lower educated participants.

Results: No differences between higher and lower educated participants were identified for pain-related disability. Significant interactions (P < .05) were found for kinesiophobia and several illness perceptions components. Bonferroni post-hoc analysis revealed a significant improvement in kinesiophobia (P < .001 and P < .002, medium effect sizes) and perceived negative consequences (P < .001 and P < .008, small effect sizes) in the PNE groups. Only the higher education PNE group showed a significant improvement in perceived illness cyclicity (P = .003, small effect size). Post-treatment kinesiophobia was significant lower in the higher educated PNE group compared to the higher educated control group (p < .001).

Conclusion: Overall, the exploratory findings suggest no clinical meaningful differences in effectiveness of PNE between higher and lower educated people. PNE is effective in improving kinesiophobia and several aspects of illness perceptions regardless of LoE.

Keywords: Back pain; Educational status; Neck pain; Physical therapy; Randomized controlled trial.

Publication types

Randomized Controlled Trial

MeSH terms

Belgium
Chronic Pain* / therapy
Educational Status
Humans
Neurosciences* / education
Pain Measurement