Effect of neurophysiological education on pain combined with therapeutic exercises in the treatment of central sensitization

Abstract

Introduction: Musculoskeletal disorders are the second leading cause of disability worldwide, and are extremely common in almost all populations, affecting both the physical and mental health of individuals, in addition to compromising their social performance. Approximately 20% of patients with musculoskeletal disorders develop chronic pain (CP). Due to its high incidence and prevalence, persistent symptoms, and high cost, CP has been considered a public health problem. Pain can be classified according to its predominance as nociceptive, peripheral neuropathic, or central sensitization. Chronic musculoskeletal conditions are subjected to ineffective conventional treatments, favoring the sensitization of the central nervous system by perpetuating nociceptive stimuli. Physiological pain education has a biopsychosocial approach and has shown good results in the treatment of patients with chronic pain when combined with other modalities, but few studies address central sensitization. Objective: To evaluate the combination of neurophysiological pain education with therapeutic exercises in the clinical improvement of patients with predominant central sensitization. Methods: Initially, an analytical observational study was carried out in 57 patients with chronic musculoskeletal pain. Neuropathic pain was defined by the DN4 instrument and the predominant central sensitization was defined by the classification of pain based on its mechanism. Eighteen patients were identified with predominant central sensitization and completed a questionnaire with sociodemographic characteristics and self-administered questionnaires on pain intensity (Numerical Pain Scale), functionality (Specific Patient Functioning Scale), quality of life (SF-12), kinesiophobia (Tampa Scale for Kinesiophobia) and catastrophizing (Pain Catastrophizing Scale). Then, 8 of the 18 patients participated in an intervention consisting of neurophysiological pain education and therapeutic exercises. Results: All patients had pain 7 days a week, being classified as severe in 88.9% of patients. High rates of catastrophizing and kinesiophobia were observed, with a high correlation between them (r=0.864; p<0.01). The mental component of quality of life showed a moderate negative correlation with catastrophizing (r=-0.611; p<0.01) and with kinesiophobia (r= -0.646; p<0.01). A moderate correlation was observed between pain intensity and catastrophizing (r=0.628; p<0.01) and with kinesiophobia (r=0.581; p=0.01). No correlation was observed between the variables age, physical component of quality of life, functionality and pain duration. All subjects reported having “improved a lot” when the perceived global effect was evaluated. Significant values ​​were observed in the improvement of patient functionality (p<0.01) and in the reduction of pain intensity (p=0.05), however, there was no statistically significant difference in the acquisition of neurophysiological knowledge of pain, in the catastrophizing or kinesiophobia index, in quality of life and in the cold water test. Conclusion: There is a moderate to high correlation between psychosocial factors, but the same correlation was not observed between the physical components. Neurophysiological education of pain associated with therapeutic exercises was able to improve functionality and reduce pain intensity in women with chronic musculoskeletal pain with predominance of central sensitization. It was not able to alter the indices of knowledge of pain physiology, catastrophizing, kinesiophobia, quality of life or descending inhibitory control of pain.