Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: a double-blind randomized controlled trial.
OBJECTIVE
There is evidence that education on pain physiology can have positive effects on pain, disability, and catastrophization in patients with chronic musculoskeletal pain disorders. A double-blind randomized controlled trial (RCT) was performed to examine whether intensive pain physiology education is also effective in fibromyalgia (FM) patients, and whether it is able to influence the impaired endogenous pain inhibition of these patients.


METHODS
Thirty FM patients were randomly allocated to either the experimental (receiving pain physiology education) or the control group (receiving pacing self-management education). The primary outcome was the efficacy of the pain inhibitory mechanisms, which was evaluated by spatially accumulating thermal nociceptive stimuli. Secondary outcome measures included pressure pain threshold measurements and questionnaires assessing pain cognitions, behavior, and health status. Assessments were performed at baseline, 2 weeks, and 3 months follow-up. Repeated measures ANOVAS were used to reveal possible therapy effects and effect sizes were calculated.


RESULTS
After the intervention the experimental group had improved knowledge of pain neurophysiology (P<0.001). Patients from this group worried less about their pain in the short term (P=0.004). Long-term improvements in physical functioning (P=0.046), vitality (P=0.047), mental health (P<0.001), and general health perceptions (P<0.001) were observed. In addition, the intervention group reported lower pain scores and showed improved endogenous pain inhibition (P=0.041) compared with the control group.


CONCLUSIONS
These results suggest that FM patients are able to understand and remember the complex material about pain physiology. Pain physiology education seems to be a useful component in the treatment of FM patients as it improves health status and endogenous pain inhibition in the long term.
*Department of Human Physiology, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel ‡Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels †Department of Health Care Sciences, Division of Musculoskeletal Physiotherapy, Artesis University College Antwerp, Antwerp ∥Private Practice for Internal Medicine, Gent/Aalst, Belgium §Nursing and Health Care, School of Medicine, University of Glasgow, Glasgow, UK.
Jessica
J
Van Oosterwijck
Mira
M
Meeus
Lorna
L
Paul
Mieke
M
De Schryver
Aurelie
A
Pascal
Luc
L
Lambrecht
Jo
J
Nijs
D059350:Chronic Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods*; D010827:Physiology / Q000193:education*; D016896:Treatment Outcome