Pain Education for Osteoarthritis

(PNE Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Lisa Carlesso, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Lisa Carlesso

No Placebo Group

Trial Summary

What is the purpose of this trial?

In this study, the investigators are comparing two types of education for older adults with knee osteoarthritis: standard biomedical education focusing on the disease process, and a newer approach called pain neuroscience education (PNE), which teaches about the complexity of pain and dispels myths. While PNE has shown benefits in self-reported pain and function, little is known about its effects on physiological responses to pain. the investigators will measure physiological indicators, particularly activity in the autonomic nervous system (ANS), which is closely linked to pain. Dysregulation in the ANS is common in chronic pain conditions like osteoarthritis. Our study aims to assess the feasibility of comparing these education methods and explore differences in physiological responses, as well as self-reported outcomes like cognitive and emotional factors. Our goals are to determine if the study protocol is feasible, assess participants' acceptance of the assessment procedures, and explore differences in physiological markers and self-reported outcomes between the two education groups. Ultimately, the investigators aim to understand how different educational approaches may affect nervous system processing in older adults with knee osteoarthritis. the investigators hypothesize that those receiving PNE will show less autonomic arousal and nervous system sensitivity compared to those receiving standard education.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Pain Education for Osteoarthritis is an effective treatment?

The available research shows that Pain Education, also known as Pain Neuroscience Education, can positively impact people with osteoarthritis by reducing their pain and improving their ability to function. One study found that when combined with regular physical therapy, Pain Education helped patients with knee osteoarthritis feel less overwhelmed by their pain and improved their daily activities. This suggests that Pain Education can be a helpful addition to other treatments for osteoarthritis. ^{1 2 3 4 5}

What safety data exists for Pain Education treatments for osteoarthritis?

The provided research does not directly address safety data for Pain Education treatments, including Pain Neuroscience Education (PNE), for osteoarthritis. However, PNE is described as an educational intervention aimed at improving understanding of pain, with studies indicating positive effects on pain ratings, dysfunctions, and pain knowledge. No specific safety concerns are mentioned in the abstracts, suggesting that PNE is generally considered safe, but detailed safety data would require further investigation. ^{1 2 4 5 6}

Is Pain Neuroscience Education a promising treatment for osteoarthritis?

Pain Neuroscience Education (PNE) is a promising treatment because it helps patients understand the biological reasons behind their pain, which can reduce pain and improve function. It is popular among healthcare providers and is being widely shared on social media. PNE is also being integrated into physical therapy education, suggesting its growing importance in pain management. ^{2 3 4 6 7}

Research Team

Lisa Carlesso, PhD

Principal Investigator

McMaster University

Eligibility Criteria

This trial is for adults over 55 with knee osteoarthritis, experiencing joint pain related to activity and minimal morning stiffness. It's aimed at community-dwelling individuals who either have a diagnosis of knee OA or meet the NICE criteria for it.

Inclusion Criteria

I have been diagnosed with knee osteoarthritis.

I experience joint pain when I move.

I am 55 years old or older.

Treatment Details

Interventions

• Pain Neuroscience Education (Behavioural Intervention)
• Standard Pain Education (Behavioural Intervention)

Trial Overview The study compares two educational methods: standard biomedical education about osteoarthritis and pain neuroscience education (PNE), which addresses the complexity of pain. The focus is on how these affect physiological responses to pain in the nervous system.

Participant Groups

Group I: Pain neuroscience education Experimental Treatment 1 Intervention

The educational content will be presented to the participants at a computer station in the format of a website to navigate to simulate the experience and information that they may come across while browsing the internet for information about knee OA. The content will include 4 components, regardless of the education type. These components include knee osteoarthritis (OA)-related images, facts and myths, disease related concepts, and patient-doctor statements. The distinction between the two educational approaches lies in how information is presented. PNE focuses more on the neurophysiology of pain and approaches it from the perspective that knee OA pain is manageable, using neutral to positive language and emphasizes the importance of physical function and staying active. After the educational content is delivered, the participants will be shown the content again and will be asked to talk aloud about each page that they were shown.

Group II: Biomedical education Active Control 1 Intervention

In Standard Pain Education, the emphasis is on the structural pathology of knee OA and the outdated but common understanding of the disease process as a degenerative one, potentially conveying negative and threatening language. After the educational content is delivered, the participants will be shown the content again and will be asked to talk aloud about each page that they were shown.

Who Is Running the Clinical Trial?

Lisa Carlesso

Lead Sponsor

Trials

1

Recruited

40+

Findings from Research

A 30-minute pain neuroscience education (PNE) lecture significantly improved pain knowledge among 133 middle school students, with scores increasing from 3.83 to 7.90 on a neurophysiology of pain questionnaire, indicating a large effect size.

The lecture also positively shifted students' beliefs about pain, particularly in understanding that the brain plays a crucial role in pain perception, demonstrating the potential of PNE to influence pain-related beliefs in younger populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education. Louw, A., Podalak, J., Zimney, K., et al.[2018]

Pain neuroscience education (PNE) significantly reduced pain catastrophization and pain intensity in patients with knee osteoarthritis after 2 weeks, compared to conventional physiotherapy alone, based on a study of 70 participants.

While PNE improved pain-related outcomes, it did not show a significant difference in patient-specific function compared to the control group, indicating that while PNE is effective for pain management, it may not directly enhance functional abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial. Supe, HM., Mungikar, SS., Katage, GA., et al.[2023]

Pain neuroscience education (PNE) combined with other treatments, particularly exercise-based interventions, appears to enhance clinical outcomes for patients with chronic musculoskeletal pain (CMP), especially in reducing psychosocial influences.

However, PNE used alone does not show significant improvements in pain intensity or disability, indicating that its effectiveness may depend on being part of a multimodal treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pain neuroscience education in patients with chronic musculoskeletal pain: an umbrella review. Cuenca-Martínez, F., Suso-Martí, L., Calatayud, J., et al.[2023]

Individuals with persistent pain tend to express more negative attitudes towards pain neuroscience education (PNE) statements compared to pain-free controls, indicating a potential barrier to the acceptance of PNE concepts in this group.

Healthcare professionals, including those with persistent pain, generally show less negativity towards PNE statements, suggesting that their training may influence their perceptions of pain education differently than those without a healthcare background.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Weisman, A., Yona, T., Gottlieb, U., et al.[2022]

The study involving 89 healthy children showed that watching a pain educational video significantly increased their pain knowledge and pain threshold compared to a control group, indicating that PNE can enhance understanding of pain in children.

However, the video did not significantly reduce experienced pain intensity, pain-related fear, or catastrophic worry, suggesting that while PNE can improve knowledge and thresholds, its effects on emotional responses to pain may vary based on age and sex.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study. Rheel, E., Ickmans, K., Wauters, A., et al.[2021]

A single lecture on Pain Neuroscience Education (PNE) significantly improved the understanding of chronic pain among Doctor of Physical Therapy (DPT) students, as shown by increased scores on the Neuroscience Pain Questionnaire (NPQ) and Health Care Providers Pain and Impairment Relationship Scale (HC-Pairs).

DPT students not only retained this knowledge for at least 6 months but also demonstrated the ability to apply their understanding of chronic pain in clinical scenarios, indicating the effectiveness of PNE as a teaching tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pain Neuroscience Education for Physical Therapy Students. Talmage, H., Wilmarth, H., Guffey, JS.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education. [2018]

2. India pubmed.ncbi.nlm.nih.gov

Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial. [2023]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Pain neuroscience education in patients with chronic musculoskeletal pain: an umbrella review. [2023]

4. Netherlands pubmed.ncbi.nlm.nih.gov

Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. [2022]

5. England pubmed.ncbi.nlm.nih.gov

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Pain Neuroscience Education for Physical Therapy Students. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Blended-Learning Pain Neuroscience Education for People With Chronic Spinal Pain: Randomized Controlled Multicenter Trial. [2019]