Pain Neuroscience Education and Exercise

Study Overview
=================
Brief Summary
-----------------
This study examined the effects of pain neuroscience education plus exercise when compared with exercise only in university students with chronic idiopathic neck pain.

Detailed Description
-----------------
This study examined the effects of pain neuroscience education plus exercise when compared with exercise only in university students with chronic idiopathic neck pain. University students with chronic neck pain were randomly allocated to receive pain neuroscience education and exercise or exercise only and assessed at baseline, after the intervention and at 3 months follow up. Outcome variables were pain intensity (primary outcome), disability, fear of movement, catastrophizing, knowledge of pain neurophysiology, pressure pain thresholds and neck and scapular muscle endurance.

Official Title
-----------------
Pain Neuroscience Education and Exercise Versus Exercise for University Students With Chronic Idiopathic Neck Pain: a Randomized, Controlled and Single Blind Study

Conditions
-----------------
Neck Pain

Intervention / Treatment
-----------------
* Other: Exercise
* Other: Pain neuroscience education


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Participants could enter the study if they had chronic idiopathic neck pain, defined as pain felt in the neck at least once a week in the previous 3 months and for which no cause had been established. Furthermore, they were required to have a minimum pain intensity in the previous week of 2 in the visual analogue scale. Exclusion Criteria: Participants were excluded if they had had physiotherapy for their neck pain in the 6 months previous to the study, if they had rheumatic, nervous, cardiac and/or respiratory pathology that could prevent or make it difficult to do the exercises. Exclusion criteria were ascertained by self-report.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: pain neuroscience education and exercise<br>This group received pain neuroscience education and exercise once a week over 4 weeks | Other: Exercise<br>* Exercises were aimed at increasing the endurance and strength of the deep neck flexor and extensor muscles and of the scapular stabilizer muscles.<br>Other: Pain neuroscience education<br>* Pain neuroscience education covered the neurophysiology of pain, transition from acute to chronic pain and the nervous system ability to modulate the pain experience.<br>|
| Active Comparator: Exercise<br>This group received exercise directed at the neck and shoulder regions once a week over 4 weeks | Other: Exercise<br>* Exercises were aimed at increasing the endurance and strength of the deep neck flexor and extensor muscles and of the scapular stabilizer muscles.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Pain intensity | Measured using the visual analogue scale | At the beginning | 
| Pain intensity | Measured using the visual analogue scale | 5 weeks | 
| Pain intensity | Measured using the visual analogue scale | At 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Deep neck flexor endurance | Method of assessment - physical test; the participant is in supine and he/she is asked to flex the upper cervical spine, move their head away from the couch approximately 2.5 cm and then maintain this position for as long as possible. The test result is the time (in seconds) that each participant holds the position. | At the beginning | 
| Deep neck flexor endurance | Method of assessment - physical test; the participant is in supine and he/she is asked to flex the upper cervical spine, move their head away from the couch approximately 2.5 cm and then maintain this position for as long as possible. The test result is the time (in seconds) that each participant holds the position. | 5 weeks | 
| Neck extensors endurance | Method of assessment - physical test; the participant is in prone and position, head neutral, and supporting 2 Kg weight hanging from it. Participants were asked to support this weight for as long as possible while maintaining the neutral head positioning. The test result is the time (in seconds) that each participant holds the position. | At the beginning | 
| Neck extensors endurance | Method of assessment - physical test; the participant is in prone and position, head neutral, and supporting 2 Kg weight hanging from it. Participants were asked to support this weight for as long as possible while maintaining the neutral head positioning. The test result is the time (in seconds) that each participant holds the position. | 5 weeks | 
| Scapular stabilizers endurance | Method of assessment - physical test; Method of assessment - physical test; Participants were standing with the shoulders and elbows flexed at 90º, while pulling both extremities of a dynamometer to reach 1 Kg of force. The test result is the time (in seconds) that each participants was able to hold this position. | At the beginning | 
| Scapular stabilizers endurance | Method of assessment - physical test; Method of assessment - physical test; Participants were standing with the shoulders and elbows flexed at 90º, while pulling both extremities of a dynamometer to reach 1 Kg of force. The test result is the time (in seconds) that each participants was able to hold this position. | 5 weeks | 
| Pressure pain thresholds | Method of assessment - psychophysical test; Pressure was applied over the trapezius and at C5-C6 with a algometer until the participant first felt pain. The results was the quantity of force (in Kgf) supported by participants. | At the beginning | 
| Pressure pain thresholds | Method of assessment - psychophysical test; Pressure was applied over the trapezius and at C5-C6 with a algometer until the participant first felt pain. The results was the quantity of force (in Kgf) supported by participants. | 5 weeks | 
| Disability | Method of assessment - the neck pain disability index | At the beginning | 
| Disability | Method of assessment - the neck pain disability index | 5 weeks | 
| Disability | Method of assessment - the neck pain disability index | 3 months | 
| catastrophizing | Method of assessment - Pain catastrophising scale | at beginning | 
| catastrophizing | Method of assessment - Pain catastrophising scale | 5 weeks | 
| catastrophizing | Method of assessment - Pain catastrophising scale | 3 months | 
| fear of movement | method of assessment - the Tampa Scale | At the beginning | 
| fear of movement | method of assessment - the Tampa Scale | 5 weeks | 
| fear of movement | method of assessment - the Tampa Scale | 3 months | 
| Knowledge of pain neurophysiology | method of assessment - scale; the neurophysiology of pain questionnaire | at beginning | 
| Knowledge of pain neurophysiology | method of assessment - scale; the neurophysiology of pain questionnaire | 5 weeks | 
| Knowledge of pain neurophysiology | method of assessment - scale; the neurophysiology of pain questionnaire | 3 months |