Effectiveness of a Psychoeducative Intervention on Patients With Cronic Low Back Pain
Condition: Back Pain Lower Back Chronic
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      One of the treatment modalities currently available in this hospital to treat this type of
      patients with low back pain who present with chronic pain are the group sessions that are
      carried out to provide information to the patient about the anatomy, biomechanics and
      ergonomics and are complemented with sessions of physical exercise. Based on the latest
      publications on treatment of this type of patients, The investigators have seen that this
      intervention is insufficient, and that it could be improved by combining education based on
      Pain Neuroscience Education (PNE)).

      The present study proposes implementing this program to a randomly assigned group of patients
      participating in the group sessions aimed at patients with lumbar pain called "Back-pain
      Protocol" that are currently relized in the Physiotherapy Area of a hospital; and compare the
      results of this intervention with those obtained in another group that will only carry out
      the sessions with the traditional method that is currently used.
    

Detailed description: 
      Procedure The physiotherapist in charge of the chronic back pain programme group ("back pain
      protocol") is contacted. The study will be explained and the materials and training to
      deliver the PNE session will be provided.

      Participants who meet the inclusion criteria will then be identified and randomised to the
      intervention or control group.

      At the end of the first session, which currently takes place in group chronic back pain
      treatment programmes, the physiotherapist will explain the study and ask for cooperation. The
      information sheet is handed out. Those who decide to participate will receive an informed
      consent form and some questionnaires to fill in: the Numeric Pain Rating Scale (NPRS) to
      assess their level of pain, the Central Sensitisation Inventory, the Pain Catastrophic Scale
      (Spanish version), the Tampa Kinesiofobia Scale (TSK).

      Interventions The current protocol consists of five sessions spread over one and a half
      months. Patients come to the rehabilitation classroom in two groups of 10 people per day for
      one hour.

      The first session consists of an informative talk. The physiotherapist gives information and
      explanations about the "back pain protocol". The physiotherapist explains the problems of
      posture and gestures that can be beneficial or detrimental to their treatment, their daily
      activities, their work and their sporting activities.

      In the second, third and fourth sessions, the participants learn specific exercises for back
      pain. Patients receive a booklet with the exercises and postures to be incorporated into
      their daily habits.

      Treatment. This study proposes that only participants assigned to the intervention group will
      also receive an additional patient education session on Pain Neuroscience Education (PNE).

      This session will last one hour and will be given in an additional session the day after the
      first information session of the current protocol. They will also be given information to
      read and review at home. Only patients randomised to the intervention group will attend this
      session.

      The aim of this intervention is to provide participants with information in a clear and
      simple way, so that they can change their attitude to pain, inviting them to take a more
      active and less contemplative role. The physiotherapist will explain to the participants in a
      simple way that chronic pain is not always the result of tissue damage. Neuroscience has
      shown that it is possible to have persistent pain without tissue damage or with damage that
      justifies the perception of disproportionate pain. The physiotherapist will also explain the
      difference between acute and chronic pain, central sensitisation processes (CS) and
      endogenous pain control mechanisms. The physiotherapist will talk about how thoughts, beliefs
      and emotions modify the painful experience and how the erroneous information received,
      sometimes iatrogenic, modifies the mechanisms of pain processing. The content of the
      neuroscience education lectures is based on the book Explain Pain.
    

Intervention name(s): Pain Neuroscience Education" (PNE)
Intervention type(s): Other
Intervention description(s): A lecture on neuroscience education (EN). The aim of this intervention is to provide participants with information in a clear and simple way so that patients can change their attitude to pain, inviting them to take a more active and less contemplative role. Neuroscience has shown that it is possible to have persistent pain without tissue damage or with damage that justifies the perceived disproportion of pain.
Other intervention name(s): Therapeutic Neuroscience Education (TNE)
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: two-armed randomized trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Central Nervous System Sensitization; kinesiophobia