Pain Neuroscience Education Combined With Cognition-targeted Motor Control Training
Condition: Chronic Spinal Pain
Study type: Interventional

Summary: 
      Chronic spinal pain (CSP) includes chronic low back pain, failed back surgery, chronic
      whiplash associated disorders, chronic non-traumatic neck pain, etc. The current
      investigators and others have provided evidence for impaired motor control of spinal muscles
      in patients with CSP. In addition, there is increasing evidence that central mechanisms, i.e.
      hyperexcitability of the central nervous system and brain abnormalities (e.g. decreased brain
      matter density) play a role in CSP. Hence, treatments for CSP should not only address the
      spinal muscles and joints, but also the brain. Therefore, a modern neuroscience approach,
      comprising of pain neuroscience education followed by cognition-targeted motor control
      training, can be applied.

      The scientific objective entails examining the effectiveness of the modern neuroscience
      approach vs. usual care evidence-based physiotherapy for reducing pain and improving
      functioning in Flemish patients with CSP. A secondary objective entails examining the
      effectiveness of the modern neuroscience approach vs. usual care evidence-based physiotherapy
      for altering brain's structure and function (magnetic Resonance Imaging) in Flemish patients
      with CSP. Therefore, a multi-center triple-blind randomized controlled trial will be
      conducted.

      To comply with this scientific objective, 120 CSP patients will be recruited and subjected to
      the baseline assessment. The baseline assessment includes the assessment of pain (including
      symptoms of central sensitization and conditioned pain modulation), the assessment of
      restrictions in functioning, brain imaging, the evaluation of motor control and muscle
      properties, spinal mobility, and psychosocial correlates. Baseline analysis will provide
      descriptive statistics and will lead to calculate correlation between the different outcome
      measures and predictors of pain and dysfunctioning. In a next step, included patients will be
      randomized to the experimental or control group. Those in the experimental group will receive
      neuroscience education combined with cognition-targeted motor control training. Those in the
      control group will be subjected to a control intervention, including back/neck school and
      general exercises. After the neuroscience education has been given, the experimental subjects
      will fill in the neurophysiology of pain test. Several follow-up assessments will take place.
      Part of the assessment (functionality (PDI questionnaire) and psychosocial correlates (Pain
      Catastrophizing Scale (PCS), pain vigilance and awareness questionnaire (PVAQ), Tampa Scale
      for Kinesiophobia (TSK), Illness Perception Questionnaire revised (IPQ-R)) will be
      re-evaluated after the first 3 sessions. The complete 'baseline' assessment will be repeated
      in the month following the treatment complement, rounding up the short-term follow-up
      assessment. Six months after the baseline assessment, pain, functioning and psychological
      correlates are assessed in an intermediate online assessment. One year after baseline
      assessment the complete assessment is repeated for the last time, unless the intermediate
      assessment indicates that treatment effects are no longer present. Both short and long term
      treatment effects can be studied and predictors for therapy success can be unraveled. Also
      correlations between changes in different outcome measures can provide relevant and
      innovative information.

      The proof of principal suggests a strong effect reported by large effect sizes for pain and
      disability compared to usual care.
    


Intervention name(s): usual care evidence-based physiotherapy; modern neuroscience approach
Intervention type(s): Other; Other
Intervention description(s): Arm 1 (i.e., the control group) will be subjected to a control intervention, including back/neck school and general exercises. 3 sessions of education (session 1: group session; session 2: online module; session 3: individual session) will be given by a physiotherapist, followed by 15 sessions of traditional physiotherapy and general exercises. The 18 sessions will be spread over a period of 3 months.; Arm 2 (i.e., the experimental group) will receive pain neuroscience education (3 sessions of education), followed by 15 sessions of cognition-targeted motor control training (15 sessions). The 18 sessions will be spread over a period of 3 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment