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Date of Award
Mark A. Lumley
Many patients’ chronic musculoskeletal pain is strongly influenced by central nervous system processes such as sensitization or amplification. Education about pain neuroscience can change patients’ beliefs but has less consistent effects on clinical outcomes. Patients may have greater clinical benefits if the educational intervention has them evaluate various psychosocial risk factors with respect to their pain. This study developed and tested a brief, internet-based Pain Psychology and Neuroscience (PPN) self-evaluation intervention. From a patient registry, 104 adults reporting chronic low back pain (CLBP; n = 54) or fibromyalgia (FM; n = 50) were randomized to the PPN intervention or a matched, active control condition. At baseline and immediate follow-up, participants reported attributions about their pain and readiness for pain self-management. At baseline and at immediate, 1-month and 10-month follow-ups, participants again reported attributions and readiness, plus pain severity and interference, psychological distress, and pain catastrophizing. Primary analyses compared the two experimental conditions using analysis of covariance (ANCOVA); exploratory analyses compared the conditions in CLBP and FM subgroups separately. At immediate follow-up, compared to the control condition, PPN led to significantly greater control (p = .08), brain (p = .14) and psychological (p = .06) attributions for pain. At 1-month follow-up, the PPN intervention led to lower pain severity (p = .05) and interference (p = .04), and greater readiness for pain self-management (p = .08), compared to controls, and sustained effects on all attribution outcomes, control (p = .07), brain (p = .07) and psychological (p = .07). Effects on distress and pain catastrophizing were not significant. Exploratory analyses showed that the PPN intervention specifically benefited patients with CLBP but not those with FM. Most of the effects (except attributions) were lost at 10 months. This trial demonstrates that a brief self-evaluation intervention can yield small, short-term improvements in pain severity and interference, especially for people with CLBP rather than FM, perhaps because a psychology/neuroscience perspective is more novel for those with CLBP.
Urbanik, Christopher P., "The Effects Of A Pain Psychology And Neuroscience Self-Evaluation Internet Intervention: A Randomized Clinical Trial" (2020). Wayne State University Theses. 809.