Mediators and Moderators of Pain Neuroscience Education on Disability of Patients With Nonspecific Chronic Low Back Pain
Condition: Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Observational [Patient Registry]

Summary: 
      The purpose of this observational study is understanding the underlying mechanisms of how PNE
      impacts disability in chronic low back pain patients (CLBP). The investigator will explore
      whether the PNE effect on patient disability is mediated by changes in pain catastrophizing,
      pain self-efficacy and patient beliefs about pain. Also, the investigator will explore
      whether the effect of PNE on disability is moderated by patient expectation.The observational
      multisite pre-post cohort study will be conducted in PT clinics in the Kingdom of Saudi
      Arabia (KSA).
    

Detailed description: 
      Low back pain (LBP) is one of the most disabling conditions and has major socio-economic
      consequences. The prevalence of LBP among the population worldwide ranges between 15 and 45%.
      In the Kingdom of Saudi Arabia (KSA), the prevalence of LBP reported being around 18.8% among
      the population. Patient beliefs about back pain, pain self-efficacy, pain catastrophizing and
      expectation all seem to play a role in recovery. In fact, clinical guidelines recommended the
      treatment of non-specific chronic LBP should be considered within a multi-factorial
      biopsychosocial (BPS) framework. Exactly how this treatment should be delivered is not clear.

      Pain neuroscience education (PNE) is a cognitive-based education that helps to educate
      patients about pain by focusing on neurobiology, neurophysiology and the processing and
      representation of pain. Even though PNE as intervention helps to improve pain, disability and
      other patient outcome, mixed results on its efficacy have seen in many studies. Since any
      complicated interventions are usually assessed by their effects on outcomes such as
      disability and pain, most do not target these outcomes directly; instead, they target
      mediating factors that are assumed to cause changes in these outcomes. In particular
      self-efficacy, pain catastrophizing and a patient's beliefs about back pain are thought to
      mediate the PNE-disability relationship since most of these cognitive factors are either
      highly correlated with disability or predictors for disability. The justifications for
      choosing these potential mediating factors: (1) self-efficacy has been shown to mediate the
      development of disability and is the most commonly identified mediator for psychological and
      behavior change interventions; (2) a study has shown that higher levels of pain
      catastrophizing are strongly correlated with higher levels of pain intensity and disability;
      and (3) a study has shown that beliefs about the consequences of LBP can influence patients'
      perceived pain and disability. However, the mechanisms underlying PNE effects, or the effect
      of PNE on mediating factors and its subsequent effect on disability as an outcome, has not
      been yet investigated. That leads to a knowledge gap in the evidence for understanding how
      PNE exerts its effect on disability. Also, identifying potential moderating factors that
      influence the PNE-disability relationship needs further investigation. In particular,
      expectation is thought to moderate the PNE-disability relationship because there are studies
      identified a link between expectation and clinical outcomes in patients with LBP. No study
      has explored the relationship between expectancy and clinical outcomes in the context of PNE.
      So, the influence of patient expectation on the magnitude of PNE effect on disability needs
      investigation.

      The purpose of this 18-months project is understanding the underlying mechanisms of how PNE
      impacts disability. This project is significant because it will help us understand how PNE
      works by studying the underlying mechanisms and for whom and under what circumstances will
      PNE produces the greatest clinical benefits on the disability for patients with chronic LBP.
      Knowing how certain factors work will help PTs to enhance the elements of PNE that hopefully
      will target patient-specific factors and subsequently will reduce disability.
    

Intervention name(s): Pain Neuroscience Education (PNE)
Intervention type(s): Behavioral
Intervention description(s): Participates in the experimental group will receive 15mins X 4 sessions of pain education by the eligible trained physical therapist in addition to usual care PT treatment.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with Nonspecific Chronic Low Back Pain (NCLBP)