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Abstract
Background: Chronic musculoskeletal (MSK) pain is a disabling condition affecting bones, muscles, ligaments, and tendons that persists beyond three months or the expected healing time. It results from various rheumatic and musculoskeletal diseases (RMD) such as Rheumatoid Arthritis, Osteoarthritis, Low Back Pain and Neck Pain, and Fibromyalgia. Clinical practice guidelines for managing chronic MSK pain recommend exercise, self-management strategies, and educational programmes. The educational programmes revolve around goal setting, skill building, self-management strategies to cope with pain (e.g., exercise), and Pain Neuroscience Education (PNE). PNE aims to educate individuals on the neurobiology underlying pain perception, emphasizing that pain is the nervous system’s interpretation of injury threat, not a measure of injury severity. A recent umbrella review by Cuenca-Martínez F. et al. revealed significant heterogeneity in PNE outcomes, emphasising the necessity for refining studies before clinical application. Thus, enhancing our understanding of the factors influencing PNE efficacy is crucial. A pivotal step towards achieving this goal involves outlining the factors that can improve PNE, starting with those who have firsthand experience.
Objectives: This study aimed to synthesise qualitative evidence concerning the experience of PNE in individuals with chronic MSK pain through a Systematic Review and Thematic Synthesis of qualitative studies to highlight factors influencing the success of PNE.
Methods: MEDLINE via Pubmed, EMBASE, Cochrane Library, CINAHL, and PsycINFO were consulted for qualitative studies. The studies had to focus on adults (age > 16 years) with a diagnosis of chronic MSK pain who received PNE to be considered eligible. The quality of the study was analysed using the Critical Appraisal Skills Programme (CASP) tool. The synthesis was done through a thematic synthesis by Thomas&Harden. The Confidence in Evidence from Reviews of Qualitative Research (CERQual) approach was used to assess the confidence in retrieved evidence.
Results: Nine studies were included, counting 188 people with chronic MSK pain (Figure 1). Ten descriptive themes were developed to synthesise the findings of the included primary studies. These themes were subsequently organised into four overarching domains, each delineating a facet of the participants’ experience with PNE. Three analytical themes (Figure 2) were developed, starting from the descriptive themes to answer our focused research question (‘What are the determinants influencing the success of PNE?’). These three themes followed a sequential pathway, commencing with the effective communication of information by the clinician to the individual (Theme 1: Efficient Communication of Information). This pathway then traverses the individual’s emotional response (Theme 2: Emotional Support and Well-being), culminating in the promotion of a constructive shift in their cognitive perspective and lived experience of pain (Theme 3: Empowerment Promotion). The studies showed good quality based on CASP, with a moderate confidence in the evidence assessed by CERQual.
Conclusion: This study comprehensively synthesises existing evidence concerning the determinants influencing PNE efficacy. This review revealed that these determinants are intricately tied to three main dimensions: effective communication and the rapport between healthcare providers and consumers, the emotional and personal aspects of the individual, and the capacity to foster empowerment. Remarkably, all these facets converge on a central theme: the customisation of the treatment. As observed in various therapeutic approaches, the primary finding from this research underscores the paramount significance of tailoring education to suit the individual. Future research should consider our results to make PNE tailored to each healthcare consumer and make their strategies more practicable, enhancing the success of this intervention.
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.
- Pain
- Qualitative research
- Patient information and education
- Systematic review