EFFECTIVENESS OF PAIN NEUROSCIENCE EDUCATION (PNE) IN PATIENTS WITH PERSISTENT PAIN DUE TO FIBROMYALGIA

Introduction:
Fibromyalgia (FM) is a rheumatologic syndrome with widespread pain as the most characteristic symptom. In a biopsychosocial context, FM is a complex multifactorial syndrome, where the presence of chronic pain could be explained by findings compatible with a central sensitization process. Currently, there are several treatment approaches for FM, but its multifactorial condition creates difficulties in the development of an effective treatment. Pain neuroscience education (PNE) is an educational intervention that aims to reconceptualize concepts about the neurophysiology of pain, as well as to reinterpret some cognitions derived from the suffering of persistent pain.

Purpose:
To assess the effects of PNE on patients with fibromyalgia (FM) in terms of pain intensity.

Methods:
A systematic review and meta-analysis of randomized controlled trials was conducted. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using the random effects model.

Results:
In the post-intervention assessment, the meta-analysis showed statistically significant differences in the pain intensity with a moderate clinical effect (7 studies, SMD:-0.78; 95% CI:-1.32– -0.23; p<0.05) with evidence of significant heterogeneity (p<0.05, I2=85%). Regarding the follow-up assessment, PNE the meta-analysis did not show statistically significant differences in favor of pain intensity. However, applying a sensitivity analysis, the meta-analysis showed a significant decrease of pain intensity with a moderate clinical effect (5 studies, SMD:-0.76; 95% CI -1.13– -0.38; p<0.05) without evidence of significant heterogeneity (p<0.05, I2=10%).

Conclusions:
There is moderate quality evidence that in patients with FM, PNE can decrease the pain intensity post-intervention. Finally, the effectiveness of PNE in follow-up is still showing some doubts. More research is needed to see the mid- and long-term impact of educational treatment strategies in fibromyalgia patients with the aim of reducing pain intensity.