PNE With Therapeutic Exercises on Pain Intensity in Lumbar Radiculopathy
Condition: Lumbar Radiculopathy
MeSH terms: Radiculopathy; Pain
Study type: Interventional

Summary: 
      There is lack of structured pain neuroscience education in patients with lumber
      radiculopathy. Previously researches were done on pain neuroscience education before surgery
      of lumber radiculopathy. However this study will provide structured educational plan about
      pain neuroscience education along with therapeutic exercises to positively influence pain
      knowledge, dysfunction, and fear avoidance, limitation in movement and healthcare utilization
      in patients who have diagnosed with lumbar radiculopathy and don't want to undergo surgery.
    

Detailed description: 
      Radicular pain or radiculopathy, defined as spinal nerve root dysfunction causing dermatomal
      discomfort and paresthesia's, myotome weakness, and/or reduced deep tendon reflexes, is
      frequently associated with axial spine pain. It affects both men and women and is believed to
      impact 3 to 5 percent of the population. Radiculopathy is pain that radiates down the legs
      and is described as electric, burning, and acute pain. Radiculopathy is most caused by
      irritation of a specific nerve, which can occur anywhere along the nerve and is most often
      caused by a compressive force. It could be caused by bulging or herniated discs, facet or
      ligamentous hypertrophy, spondylolisthesis, or even neoplastic or infectious diseases.

      LR is the second leading cause of disability according to a research published by Global
      Burden of Disease (GBD).Pain neuroscience education (PNE), also known as therapeutic
      neuroscience education (TNE), is a series of instructional sessions for patients that cover
      the neurobiology and neurophysiology of pain, as well as how the nervous system processes
      pain. PNE alters the way a patient perceives pain at first. For example, a patient may have
      assumed that damaged tissues were the source of their pain; yet, after learning more about
      pain neurophysiology, the patient realises that pain may not accurately reflect tissue health
      and instead be caused by extra-sensitive nerves.
    

Intervention name(s): Structured pain neuroscience education; Conventional Treatment
Intervention type(s): Other; Other
Intervention description(s): Structured pain neuroscience
Neurophysiology of pain
The PNE occurred with the use of pictures, examples, metaphors and drawings as needed
Metaphor Alarm system: Your nerves working like an alarm system to protect you.
BOOKLET Consist of education about pain neurophysiology.(31)
Steps of booklet :
Extract content
English to Urdu translation
Content Validity
Expert Panel review by Physiotherapists
Content validity Analysis review(Focus Group)
Pilot study 4 to 5 patients
Content improved (PNE) and Finalized
After Analysis RCT; ELECTROTHERAPY MODALTIES-15 min
IFC (interferential current)IFC will be administered using following parameters: 80-150 watts, 4000 Hz, sweep on, 16.0-17.0 CV(26)
Hot pack(27)
Therapeutic exercises
Strengthening (Back extensors, quadriceps, hamstring and VMO, gluteus maximums, gluteus medius, transverse abdominis.
Stretching hamstring and, calf stretching. Soft tissue mobilization(5) McKenzie based exercises(28) BALANCE EXERCISES
Single Leg Stance (static balance) Patient is instructed to stand on one leg,close his/her eyes and maintain this position as long as they could.
Tandem gait (dynamic balance) patient is instructed to walk a total of 5 laps on a 2-meter-long line with the heel of the front foot touching the fingertip of the back foot.(29)
POSTURAL TRAINING
good posture when sitting standing and while driving
Avoid weight lifting
Avoid too much bed rest
Sit in firm places. (30)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other