Pain Neuroscience Education and Exercise in High School Students With Chronic Idiopathic Neck Pain
Condition: Chronic Neck Pain
MeSH terms: Neck Pain
Study type: Interventional

Summary: 
      Musculoskeletal pain can affect up to 40% of children and adolescents. Neck pain (NP) is one
      of the most prevalent painful conditions and evidence suggests that its prevalence has
      increased in recent decades in adolescents aged 16 to 18 years, from 22.9% in 1991 to 29.5%
      in 2011. Interventions based on pain neuroscience education have emerged as promising
      strategies in chronic pain conditions.In adults this intervention has been explored in many
      pain conditions, including musculoskeletal pain, but there is only one pilot study in
      adolescents with chronic NP and one case study in adolescents with fibromyalgia.

      Thus, the main objective of the present study is:

      (i) To compare the effectiveness of an education program based on pain neuroscience education
      and exercise versus exercise alone, in decreasing pain intensity in secondary school students
      with chronic and idiopathic NP immediately after the intervention and at 6 months.

      The secondary objectives are to:

      i) Compare the effectiveness of these programs immediately after the intervention and at 6
      months in i) disability, ii) sleep, iii) pain catastrophizing, iv) fear of movement, v)
      self-efficacy, vi) central sensitization vii) the strength of the deep neck flexors and
      extensors muscles and stabilizers of the scapula; and viii) the pressure pain threshold
      between the two intervention groups;

      ii) Explore possible predictors of response to treatment.
    

Detailed description: 
      It is anticipated that the sample will consist of 127 participants from four secondary
      schools that will be divided into two groups. Both groups will receive the same
      exercise-based intervention. The experimental group will receive, in addition to exercise, an
      intervention based on pain neuroscience education. The intervention will consist of 1 session
      per week during 8 weeks and will be applied in small groups.

      The intervention will be performed in a blended-learning format. Five sessions will be
      face-to-face with up to 45 minutes duration, performed at school and incorporated into
      physical education classes and 3 will be performed at home, supported by vídeos sent by
      WhatsApp. The first two sessions will always be face-to-face. Face-to-face sessions will be
      interspersed with WhatsApp sessions.

      Participants will be assessed, by online questionnaires, for sociodemographic aspects, pain
      characterization and physical activity level, disability, sleep, catastrophizing, fear of
      movement, self-efficacy, central sensitization and knowledge on pain neurophysiology. In
      addition, 3 muscle tests will be performed for the deep neck flexor and extensor muscles and
      scapular stabilizers, and the pressure pain thresholds in the neck and at distance will be
      assessed.
    

Intervention name(s): Pain Neuroscience Education and Exercise; Exercise
Intervention type(s): Other; Other
Intervention description(s): The incorporation of the exercise in this group will be gradual, in order to decrease the education component and increase the exercise component (up to 45/60 minutes). The 1st session will be only PNE and will last approximately 45 minutes. In the 2nd session, there will be 30 minutes of PNE and the remaining 15 minutes of exercise. In the following 4th and 6th sessions, 15 minutes of each session will be used to clarify doubts and emphasize PNE concepts and strategies. The 8th session will include exercises only. In WhatsApp sessions, in addition to the video with the exercises, participants will receive activities about the PNE.; The exercise group will perform exercises in all sessions (45 minutes of exercise in face-to-face sessions). In WhatsApp sessions, participants will receive a video with exercises to perform at home.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Chronic Neck Pain; Adolescents; Pain Neuroscience Education; Exercise