Effectiveness of Pain Neuroscience Education on Pain and Psychological Factors in Adults with Chronic Neck Pain: Systematic Review

Abstract

Background: Chronic neck pain (CNP) is a common musculoskeletal disorder associated with psychological factors, such as catastrophising and kinesiophobia. Pain neuroscience education (PNE) is an educational intervention aiming to improve understanding of pain neurophysiology. Objective: This review aims to evaluate PNE's effectiveness on pain, pain catastrophising and kinesiophobia in adults with CNP. Methods: A systematic search for randomised controlled trials (RCTs) involving PNE for adults with CNP was conducted in CINAHL, PubMed, Ovid Medline, Cochrane and PEDro through June 2023. The outcomes were pain, pain catastrophising, and kinesiophobia. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool, and certainty of evidence was evaluated via the GRADEpro online utility. Results: Three RCTs with 192 participants were included. A meta-analysis was not feasible due to heterogeneity. The narrative synthesis found inconsistent PNE effects on pain. One study found that PNE plus dry needling significantly reduced pain compared to usual care at post-intervention only (p < 0.01). Two studies showed no statistically significant differences in catastrophising, although the changes were clinically meaningful. While the results regarding kinesiophobia were mixed, two studies found that PNE significantly reduced kinesiophobia versus controls (p < 0.05) at all three time points after intervention (post-intervention, at one month and after three months), while one study found no difference. The RoB assessment showed a low RoB in two studies and an uncertain RoB in one study. Overall, the certainty of evidence was low to very low. Synthesis Methods: The findings from the included studies were summarised narratively. Conclusion: The effectiveness of PNE for CNP remains inconclusive due to inconsistent findings from a limited number of studies. Higher quality RCTs using standardised PNE protocols are needed to establish definitive conclusions. Currently, PNE may be considered a safe adjunct intervention, but efficacy is uncertain for CNP management.