Subscribe to RSS
DOI: 10.1055/a-2503-6229
Therapeutic Neuroscience Education In Fibromyalgia: A Randomized Controlled Trial
Therapeutic Neuroscience Education (TNE) bei Fibromyalgie: eine randomisierte kontrollierte Studie This study was supported by Pamukkale University Scientific Research Projects Coordination Unit (Project No: 2019SABE010).Registration number (trial ID): NCT05435807, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Randomized

Abstract
Objective
To investigate additive effect of Therapeutic Neuroscience Education (TNE) to pilates exercises in female patients with fibromyalgia (FM).
Method
25 female patients FM included in the study. They randomly separated into two groups. There were 11 patients in the intervention group and 14 patients in the control group. Pilates exercises and TNE were applied in the intervention group, and only pilates exercises were applied in the control group. Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), Visual Analogue Scale (VAS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), Fibromyalgia Impact Questionnare (FIQ), Symptom Severity Scale (SSS), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Biopsychosocial Questionnaire (BETY-BQ) and pressure algometer was used for evaluation.
Results
After the treatment, control group improved in the “visuomotor construction” and “thinking operations"cognitive areas andtotal score of DLOTCA, BPI-pain severity score, VAS, FIQ, SSS, PCS-magnification, and only left medial knee mean score of pressure pain thresholds (p<0.05). Intervention group improved in the “thinking operations” cognitive area and total score of DLOTCA, BPI-pain severity score, BPI-pain interference score, VAS, WPI, FIQ, SSS, TSK, BETY-BQ and all pressure pain thresholds (excluding left trapezius) (p<0.05). In the comparison of delta values, the intervention group improved more in WPI, FIQ, right trapezius mean score and left trapezius, right quadriceps femoris, right-left medial knee maximum and mean scores of pressure pain thresholds (p<0.05).
Conclusion
TNE increased the effectiveness of pilates exercises on pain, functional status and pressure pain thresholds in patients with FM.
Zusammenfassung
Ziel
Ziel der Studie war es, die additive Wirkung von therapeutischer neurowissenschaftlicher Ausbildung (Therapeutic Neuroscience Education, TNE) bei Fibromyalgie (FM) zu untersuchen.
Methode
In die Studie wurden 25 Patientinnen mit FM aufgenommen und randomisiert in zwei Gruppen eingeteilt: 11 Patientinnen in die Interventionsgruppe und 14 in die Kontrollgruppe. In der Interventionsgruppe kamen Pilates-Übungen und TNE zur Anwendung, in der Kontrollgruppe nur Pilates-Übungen. Die folgenden Instrumente wurden zur Prüfung verwendet: Dynamic Loewenstein Occupational Therapy Cognitive Assessment (DLOTCA), visuelle Analog-Skala (VAS), Brief Pain Inventory (BPI), Widespread Pain Index (WPI), Fibromyalgia Impact Questionnare (FIQ), Symptom Severity Scale (SSS), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), Biopsychosocial Questionnaire (BETY-BQ) und Druckalgometrie.
Ergebnisse
Nach der Behandlung fanden sich in der Kontrollgruppe Verbesserungenin der Kognition in den Bereichen „visuomotorische Konstruktion” und „Denkoperationen“ sowie im Gesamtscore von DLOTCA, BPI-Schmerzschweregrad-Score, VAS, FIQ, SSS, PCS-Magnification und nur im mittleren Score der medial am linken Knie bestimmten Druckschmerz-Schwellen (p<0,05). Die Interventionsgruppe zeigte Verbesserungen in der Kognition im Bereich „Denkoperationen“ sowie im Gesamtscore von DLOTCA, BPI-Schmerzschweregrad-Score, BPI-Schmerz-Interferenz-Score, VAS, WPI, FIQ, SSS, TSK, BETY-BQ und alle Druckschmerzschwellen (außer linker M. trapezius) (p<0,05). Der Vergleich der Delta-Werte ergab für die Interventionsgruppe stärkere Verbesserungen hinsichtlich WPI, FIQ, des mittleren Scores für den rechten und linken M. trapezius, rechten M. quadriceps femoris, das Maximum am medialen Knie rechts-links und des mittleren Scores der Druckschmerzschwellen (p<0,05).
Schlussfolgerung
TNE verbesserte die Wirkung von Pilates-Übungen auf Schmerzen, Funktionsstatusund Druckschmerzschwellen bei Patientinnen mit FM.
Publication History
Received: 21 October 2024
Accepted: 13 December 2024
Article published online:
14 January 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Alvarez MC, Albuquerque MLL, Neiva HP, Cid L, Rodrigues F, Teixeira DS. et al. Exploring the Relationship between fibromyalgia-related fatigue, physical activity, and quality of life. Int J Environ Res Public Health 2022; 19: 4870
- 2 Schaefer C, Chandran A, Hufstader M, Baik R, McNett M, Goldenberg D. et al. The comparative burden of mild, moderate and severe fibromyalgia: results from a cross-sectional survey in the United States. Health Qual Life Outcomes 2011; 9: 71
- 3 Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L. The prevalence and characteristics of fibromyalgia in the general population. Arthritis Rheum 1995; 38: 19-28
- 4 Stahl SM. Fibromyalgia-pathways and neurotransmitters. Hum Psychopharmacol 2009; 24: 11-17
- 5 Bourke JH, Wodehouse T, Clark LV, Constantinou E, Kidd BL, Langford R, Mehta V, White PD. Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study. J Psychosom Res 2021; 150: 110624
- 6 Garcia-Hernandez A, de la Coba P, Reyes Del Paso GA. Central sensitisation pain and autonomic deficiencies in fibromyalgia. Clin Exp Rheumatol 2022; 40: 1202-1209
- 7 Tesio V, Torta DM, Colonna F, Leombruni P, Ghiggia A, Fusaro E. et al. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res 2015; 67: 143-150
- 8 Koca TT. Cognitive dysfunction in fibromyalgia. Archives Medical Review Journal 2015; 24: 105-118
- 9 Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E. et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318-328
- 10 Andrade A, Dominski FH, Sieczkowska SM. What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review. Semin Arthritis Rheum 2020; 50: 1465-1480
- 11 Latey P. The Pilates method: history and philosophy. J Bodyw Mov Ther 2001; 5: 275-282
- 12 de Aguiar AS, do Amaral JN, Carvalho CA, de Araújo WN, Sales MSC, Portilho JA. et al. Effects of pilates method in fibromyalgia patients: an integrative review. Int J Dev Res 2020; 10: 37378-37381
- 13 Komatsu M, Avila MA, Colombo MM, Gramani-Say K, Driusso P. Pilates training improves pain and quality of life of women with fibromyalgia syndrome. Revista Dor 2016; 17: 274-278
- 14 Nijs J, van Wilgen CP, Van Oosterwijck J, van Ittersum M, Meeus M. How to explain central sensitization to patients with “unexplained” chronic musculoskeletal pain: practice guidelines. Man Ther 2011; 16: 413-418
- 15 Moseley GL. Joining forces – combining cognition-targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain. J Man Manip Therap 2003; 11: 88-94
- 16 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain 2004; 8: 39-45
- 17 Moseley GL. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother 2002; 48: 297-302
- 18 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother 2005; 51: 49-52
- 19 Areso-Bóveda PB, Mambrillas-Varela J, García-Gómez B, Moscosio-Cuevas JI, González-Lama J, Arnaiz-Rodríguez E. et al. Effectiveness of a group intervention using pain neuroscience education and exercise in women with fibromyalgia: a pragmatic controlled study in primary care. BMC Musculoskelet Disord 2022; 23: 323
- 20 Saracoglu I, Leblebicier MA, Yaman F, Kavuncu V. Pain neuroscience education combined with usual treatment for fibromyalgia syndrome: A randomized controlled trial. Int J Rheum Dis 2021; 24: 1409-1418
- 21 Serrat M, Sanabria-Mazo JP, Almirall M, Musté M, Feliu-Soler A, Méndez-Ulrich JL. et al. Effectiveness of a Multicomponent Treatment Based on Pain Neuroscience Education, Therapeutic Exercise, Cognitive Behavioral Therapy, and Mindfulness in Patients With Fibromyalgia (FIBROWALK Study): A Randomized Controlled Trial. Phys Ther 2021; 101: pzab200
- 22 Barrenengoa-Cuadra MJ, Muñoa-Capron-Manieux M, Fernández-Luco M, Angón-Puras LÁ, Romón-Gómez AJ, Azkuenaga M. et al. Effectiveness of a structured group intervention based on pain neuroscience education for patients with fibromyalgia in primary care: A multicentre randomized open-label controlled trial. Eur J Pain 2021; 25: 1137-1149
- 23 Serrat M, Almirall M, Musté M, Sanabria-Mazo JP, Feliu-Soler A, Méndez-Ulrich JL. et al. Effectiveness of a Multicomponent Treatment for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): A Pragmatic Randomized Controlled Trial. J Clin Med 2020; 9: 3348
- 24 Saracoglu I, Akin E, Aydin Dincer GB. Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis. Int J Rheum Dis 2022; 25: 394-404
- 25 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Hauser W, Katz RL. et al 2016 Revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin Arthritis Rheum 2016; 46: 319-329
- 26 Wolfe F. New American College of Rheumatology criteria for fibromyalgia: a twenty-year journey. Arthritis Care Res (Hoboken) 2010; 62: 583-584
- 27 Jensen KB, Kosek E, Wicksell R, Kemani M, Olsson G, Merle JV. et al. Cognitive behavioral therapy increases pain-evoked activation of the prefrontal cortex in patients with fibromyalgia. Pain 2012; 153: 1495-1503
- 28 Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med Rehabil 2011; 92: 2041-2056
- 29 Itzkovich M, Averbuch S, Elazar B, Katz N. Lowenstein Occupational Therapy Cognitive Assessment (LOTCA) battery. 2nd ed. Pequannock, NJ: Maddak; 2000
- 30 Katz N, Livni L, Bar-Haim Erez A, Averbuch S. Dynamic Lowenstein Occupational Therapy Cognitive Assessment (DLOTCA). Pequannock, NJ: Maddak; 2011
- 31 Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singapore 1994; 23: 129-138
- 32 Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 1990; 13: 227-236
- 33 Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P. et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care Res (Hoboken) 2010; 62: 600-610
- 34 Burckhardt CS, Clark SR, Bennet RM. The fibromiyalgia impact questionnaire: development and validation. J Rheumatol 1991; 18: 728-733
- 35 Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995; 62: 363-372
- 36 Sullivan MJL, Bishop SC, Pivik J. The pain catastrophizing scale:development and validation. Psychol Assess 1995; 7: 524-532
- 37 Unal E, Arın G, Karaca NB, Kiraz S, Akdoğan A, Kalyoncu U. et al. Development of a quality of life measurement for rheumatic patients: item pool construction. JETR 2017; 4: 67-75
- 38 Okifuji A, Turk DC, Sinclair JD, Starz TW, Marcus DA. A standardized manual tender point survey. I. Development and determination of a threshold point for the identification of positive tender points in fibromyalgia syndrome. J Rheumatol 1997; 24: 377-383
- 39 Téllez-García M, de-la-Llave-Rincón AI, Salom-Moreno J, Palacios-Ceña M, Ortega-Santiago R, Fernández-de-las-Peñas C. Neuroscience Education in Addition to Trigger Point Dry Needling for The Management of Patients with Mechanical Chronic Low Back Pain: A Preliminary Clinical Trial. J Bodyw Mov Ther 2015; 19: 464-472
- 40 Fitzcharles MA, Ste-Marie PA, Goldenberg DL, Pereira JX, Abbey S, Choiniere M. et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: executive summary. Pain Res Manag 2013; 18: 119-126
- 41 MacFarlane G, Kronisch C, Dean L, Atzeni F, Häuser W, Fluß E. et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 2017; 76: 318-328
- 42 de Medeiros SA, de Almeida Silva HJ, do Nascimento RM, da Silva Maia JB, de Almeida Lins CA, de Souza MC. Mat Pilates is as effective as aquatic aerobic exercise in treating women with fibromyalgia: a clinical, randomized and blind trial. Adv Rheumatol 2020; 60: 21
- 43 Palekar T, Basu S. Comparative study of pilates exercise verses yogasana in the treatment of fibromyalgia syndrome: a pilot study. Int J Pharm Bio Sci 2014; 5: 410-420
- 44 Ekici G, Unal E, Akbayrak T, Vardar-Yağlı N, Yakut Y, Karabulut E. Effects of active/passive interventions on pain, anxiety, and quality of life in women with fibromyalgia: Randomized controlled pilot trial. Women Health 2017; 57: 88-107
- 45 de Aguiar AS, do Amaral JN, Carvalho CA, de Araújo WN, Sales MSC, Portilho JA. et al. Effects of pilates method in fibromyalgia patients: an integrative review. Int J Dev Res 2020; 10: 37378-37381
- 46 Ramsay C, Moreland J, Ho M, Joyce S, Walker S, Pullar T. An observer-blinded comparison of supervised and unsupervised aerobic exercise regimens in fibromyalgia. Rheumatology 2000; 39: 501-505
- 47 Borisovskaya A, Chmelik E, Karnik A. Exercise and Chronic Pain. Adv Exp Med Biol 2020; 1228: 233-253
- 48 Fernandes J, Arida RM, Gomez-Pinilla F. Physical exercise as an epigenetic modulator of brain plasticity and cognition. Neurosci Biobehav Rev 2017; 80: 443-456
- 49 Mandolesi L, Polverino A, Montuori S, Foti F, Ferraioli G, Sorrentino P. et al. Effects of Physical Exercise on Cognitive Functioning and Wellbeing: Biological and Psychological Benefits. Front Psychol 2018; 9: 509
- 50 Hariprasad VR, Koparde V, Sivakumar PT, Varambally S, Thirthalli J, Varghese M. et al. Randomized clinical trial of yoga-based intervention in residents from elderly homes: Effects on cognitive function. Indian J Psychiatry 2013; 55: S357-S363
- 51 Sun J, Kanagawa K, Sasaki J, Ooki S, Xu H, Wang L. Tai chi improves cognitive and physical function in the elderly: A randomized controlled trial. J Phys Ther Sci 2015; 27: 1467-1471
- 52 Pereira AC, Huddleston DE, Brickman AM, Sosunov AA, Hen R, McKhann GM. et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proc Natl Acad Sci U.S.A 2007; 104: 5638-5643
- 53 Chieffi S, Messina G, Villano I, Messina A, Valenzano A, Moscatelli F. et al. Neuroprotective effects of physical activity: evidence from human and animal studies. Front Neurol 2017; 8: 188
- 54 Moseley GL. Reconceptualising pain acording to modern pain sciences. Phys Ther Rev 2007; 12: 169-178
- 55 Zusman M. Belief reinforcement: one reason why costs for low back pain have not decreased. J Multidiscip Health 2013; 6: 197-204
- 56 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain 2004; 20: 324-330
- 57 Pires D, Cruz EB, Caeiro C. Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial. Clin Rehabil 2015; 29: 538-547
- 58 Van Ittersum MW, van Wilgen CP, van der Schans CP, Lambrecht L, Groothoff JW, Nijs J. Written Pain Neuroscience Education in Fibromyalgia: A Multicenter Randomized Controlled Trial. Pain Practice 2013; 14: 689-700
- 59 Malfliet A, Van Oosterwijck J, Meeus M, Cagnie B, Danneels L, Dolphens M. et al. Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study. Physiother Theory Pract 2017; 33: 653-660
- 60 Dick BD, Verrier MJ, Harker KT, Rashiq S. Disruption of cognitive function in fibromyalgia syndrome. Pain 2008; 139: 610-616
- 61 Schmidt-Wilcke T, Wood P, Lürding R. Cognitive impairment in patients suffering from fibromyalgia. An underestimated problem. Schmerz 2010; 24: 46-53