Effect of pain neuroscience education⁺ (PNE⁺) in people with different mechanisms of chronic pain: A systematic review and meta-analysis

Background: Chronic pain poses a multifaceted and prevalent challenge that significantly affects an individual's quality of life. Sensory mechanisms, behavioural components (kinesiophobia and catastrophising), and social factors can influence pain perception in both younger and older populations. Moreover, the mechanisms underlying these altered pain phenotypes require further investigation in order to plan appropriate treatment. While Pain Neuroscience Education (PNE) has proven effective in managing chronic pain and previous research has been conducted on PNE physiotherapeutic techniques, there remains insufficient evidence on the efficacy of these adjunctive treatments.

Objective: The objective of the present systematic review and meta-analysis was to evaluate the evidence for the efficacy of PNE + PT (PNE⁺) on pain as a primary outcome and 12 other psychosocial variables as secondary outcomes in patients with different pain mechanisms, and whether PNE⁺ could be applied to painful diabetic neuropathy.

Methods: A thorough literature search was conducted in the database Scopus, MEDLINE/PubMed, ScienceDirect, CINAHL, and Web of Science, using keywords like "Pain Neuroscience Education", and "Chronic Pain" from 2010 to 2024 based on inclusion and exclusion criteria. Twenty of the 2558 studies that underwent screening qualified for a meta-analysis and 24 of them for a systematic review. Cochrane Risk of Bias 2 was used to assess the quality of the studies. Forest plots were generated using the Revman 5.3 software.

Results: Studies that predominantly addressed central sensitization and neuropathic pain demonstrated moderate-to good-quality evidence. The review findings indicate that PNE⁺ is effective in reducing experienced pain intensity and experienced pain interference on the Visual Analogue Scale (VAS: SMD -0.70, 95% CI -1.26 to -0.14), Numerical Pain Rating Scale (NPRS SMD -1.71, 95% CI -2.34 to -1.08), reduced kinesiophobia (Tampa scale of Kinesiophobia: SMD -5.29, 95% CI -7.33 to -3.25), and catastrophizing (pain catastrophizing scale: -3.82, 95% CI -6.44 to -1.21).

Conclusion: PNE ⁺ has been found to be an effective intervention for reducing perceived pain experience, pain interference and other psychosocial variables in the management of chronic pain with different pain mechanisms. Most studies have focused on central sensitization, urging future research to explore PNE⁺ efficacy in neuropathic pain, such as painful diabetic neuropathy.

Prospero registration number: CRD42023451101.