A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-term outcomes of pain and disability

Background The evidence supporting the application of pain neuroscience education (PNE) in patients with chronic low back pain (LBP) remains some arguments.Objective This review aims to investigate the effect of PNE alone and combined with physical therapy or exercise for chronic LBP.Methods PubMed, Embase, Web of Science, and the Cochrane databases were searched from establishment to June 3, 2023. Randomized controlled trials (RCT) evaluating the effect of PNE in patients with chronic LBP were considered eligible. Data were analyzed using a random-effects model (I2 >50%) or a fixed-effects model (I2 <50%) and trials were appraised using the Cochrane ROB tool. Meta-regression was conducted to assess the moderator factors.Results Seventeen studies (1078 participants) were included in this review. PNE plus exercise and PNE plus physiotherapy both showed a reduction of short-term pain (mean differences [MD] −1.14 [−1.55, −0.72]; MD −1.15 [−1.67, −0.64]) and disability (standardized mean difference [SMD] −0.80 [−1.13, −0.47]; SMD −0.85 [−1.29, −0.40]) than physiotherapy or exercise alone. Meta-regression showed that only single PNE session duration was associated with a greater reduction in pain (P < .05). Subgroup results showed that a single PNE session exceeding 60 minutes (MD −2.04), 4 to 8 sessions (MD −1.34), intervention for 7 to 12 weeks (MD −1.32), and a group-based approach (MD −1.76) may be more beneficial.Conclusion This review indicates that adding PNE to treatment programs would lead to more efficacious effects for chronic LBP. Additionally, we preliminarily extracted dose-effect relationships for PNE intervention, providing guidance for clinicians to design effective PNE sessions.