The effectiveness of pain neuroscience education in people with chronic nonspecific low back pain: An umbrella review with meta-analysis

Abstract

Background: Chronic non-specific low back pain (CNLBP) affects millions worldwide and is a major contributor to disability and healthcare costs. Pain neuroscience education (PNE) aims to improve understanding of pain mechanisms, reduce maladaptive beliefs, and promote active coping strategies. Objective: To evaluate the effectiveness of pain neuroscience education (PNE) on pain intensity, frequency, disability, and quality of life in adults with chronic non-specific low back pain (CNLBP). Design: Umbrella review (UR) (PROSPERO, CRD42023382825). Literature search: A comprehensive search was conducted in 8 databases, covering April 2014 to April 2024. Study selection criteria: Inclusion: adults with CNLBP, PNE interventions provided by healthcare professionals, and systematic reviews (SRs) of randomized controlled trials (RCTs). Exclusion: studies focusing solely on psychological or physical aspects. Data synthesis: Data on pain intensity, pain frequency, disability, and quality of life measured using validated scales were extracted. The results were shown according to the type of intervention and the period evaluated (short or long-term). Results: Nineteen SRs with 5200 participants were included. Five studies (1120 participants) showed significant short-term pain reductions with PNE alone but inconsistent long-term effects. Four studies (860 participants) showed enhanced pain reduction with PNE combined with physiotherapy or exercise. Ten studies (3220 participants) indicated that combining PNE with other educational and biopsychosocial interventions led to more sustained pain reductions. Six studies were included in a quantitative review assessing PNE combined with exercise, with MD (mean difference) for pain, -1.11 (95 % CI, -1.57 to -0.66). For disability, SMD (standardized mean difference) was -0.42 (95 % CI, -1.09 to 0.24). Conclusions: PNE decreases pain intensity in CNLBP, with improved outcomes when combined with physiotherapy, exercise, or additional educational and biopsychosocial strategies. A multidisciplinary approach, including PNE, is recommended. Further research using standardized tools and diverse populations is needed to enhance the efficacy and generalizability of PNE interventions. Perspective: This umbrella review (UR) demonstrates that PNE can effectively reduce pain intensity and disability in CNLBP, especially when combined with physiotherapy, exercise, or biopsychosocial approaches, and it launches new hypotheses about how PNE may work. Adding PNE to different interventions may enhance participant outcomes and support more sustained pain relief.