The objective of our study is to evaluate the effects of a therapeutic intervention including 1-hour of pain neuroscience education session, 30-minutes of exposure to exercise with virtual realit and therapeutic exercise in patients with chronic low back pain.
Chronic low back pain is the world's leading cause of years of life lived with disability. Negative thoughts and beliefs about pain experienced can lead to pain avoidance behaviours. Fear of movement is a common behaviour in this type of patients and is associated with avoidance of exercise. Virtual reality is a powerful distraction technique as it directs the patient's attention to an external stimulus rather than pain or body movement. Therefore, it can be beneficial to avoid some pain-related problems, such as kinesiophobia and inactivity. Moreover, pain neuroscience education aim to reconceptualise pain perceptions, beliefs, and avoidance behaviours. Then, the use of these interventions may be beneficial in the treatment of patients with chronic low back pain. The objective of this study is to evaluate the effects of a therapeutic intervention using pain neuroscience education and virtual reality in patients with chronic low back pain.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
40
Patients will receive 1-hour pain neuroscience education session + 30-minutes exposure to exercise with virtual reality + therapeutic exercise
Patients will receive therapeutic exercise
University of Granada
Granada, Spain
University of Granada
Granada, Spain
Pain Intensity
To assess pain intensity using the Numeric Pain Rating Scale. Scores range from 0 (no pain) to 10 (worst pain imaginable). Higher scores indicate greater intensity.
Time frame: Pre-intervention
Pain Intensity
To assess pain intensity using the Numeric Pain Rating Scale. Scores range from 0 (no pain) to 10 (worst pain imaginable). Higher scores indicate greater intensity.
Time frame: 48-72h after the intervention
Pain Intensity and Interference
To assess pain intensity and interference using the Brief Pain Inventory (BPI). Scores range from 0 (no pain/does not interfere) to 10 (worst pain imaginable/completely interferes). Higher scores indicate greater intensity and interference.
Time frame: Pre-intervention
Pain Intensity and Interference
To assess pain intensity and interference using the Brief Pain Inventory (BPI). Scores range from 0 (no pain/does not interfere) to 10 (worst pain imaginable/completely interferes). Higher scores indicate greater intensity and interference.
Time frame: 48-72h after the intervention
Neurophysiology of Pain
To assess neurophysiology of pain using the Neurophysiology of Pain Questionnaire (NPQ). Scores range from 0 to 13 (sum of all correct items).
Time frame: Pre-intervention
Neurophysiology of Pain
To assess neurophysiology of pain using the Neurophysiology of Pain Questionnaire (NPQ). Scores range from 0 to 13 (sum of all correct items).
Time frame: 48-72h after the intervention
Pain-Self Efficacy
To assess pain-self efficacy using 10 items Pain Self-Efficacy Questionnaire (10-PSEQ). Scores range from 0 (not at all confident) and 6 (completely confident). A total score is calculated by summing the scores for each of the 10 items, yielding a maximum possible score of 60. Higher scores reflect stronger self-efficacy beliefs.
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Time frame: Pre-intervention
Pain-Self Efficacy
To assess pain-self efficacy using 10 items Pain Self-Efficacy Questionnaire (10-PSEQ). Scores range from 0 (not at all confident) and 6 (completely confident). A total score is calculated by summing the scores for each of the 10 items, yielding a maximum possible score of 60. Higher scores reflect stronger self-efficacy beliefs.
Time frame: 48-72h after the intervention
Awareness, Consciousness, Vigilance and Observation of pain
To assess awareness, consciousness, vigilance and observation of pain using the Pain Vigilance and Awareness Questionnaire (PVAQ). Scores range from 0 (never) to 5 (always). The total questionnaire scores range between 0 and 80. Higher scores indicate greater awareness, consciousness, vigilance and observation of pain.
Time frame: Pre-intervention
Awareness, Consciousness, Vigilance and Observation of pain
To assess awareness, consciousness, vigilance and observation of pain using the Pain Vigilance and Awareness Questionnaire (PVAQ). Scores range from 0 (never) to 5 (always). The total questionnaire scores range between 0 and 80. Higher scores indicate greater awareness, consciousness, vigilance and observation of pain.
Time frame: 48-72h after the intervention
Catastrophizing of pain
To assess catastrophizing of pain using the Pain Catastrophizing Scale (PCS). Scores range from 0 (nothing at all) to 4 (all the time). The final score range between 0 and 52 points, with higher scores indicating greater levels of catastrophism.
Time frame: Pre-intervention
Catastrophizing of pain
To assess catastrophizing of pain using the Pain Catastrophizing Scale (PCS). Scores range from 0 (nothing at all) to 4 (all the time). The final score range between 0 and 52 points, with higher scores indicating greater levels of catastrophism.
Time frame: 48-72h after the intervention
Fear and avoidance beliefs
To assess fear and avoidance beliefs using Fear and Avoidance Beliefs Questionnaire (FABQ). Scores range from 0 (totally disagree) to 6 (totally agree). The total score range from 0 to 96, with a higher value reflecting a higher degree of fear avoidance beliefs.
Time frame: Pre-intervention
Fear and avoidance beliefs
To assess fear and avoidance beliefs using Fear and Avoidance Beliefs Questionnaire (FABQ). Scores range from 0 (totally disagree) to 6 (totally agree). The total score range from 0 to 96, with a higher value reflecting a higher degree of fear avoidance beliefs.
Time frame: 48-72h after the intervention
Kinesiophobia
To assess kinesiophobia using the TAMPA Scale of Kinesiophobia (TSK). Scores range from 1 (totally disagree) to 4 (totally agree). The final score can range between 11 and 44 points, with higher scores indicating greater perceived kinesiophobia.
Time frame: Pre-intervention
Kinesiophobia
To assess kinesiophobia using the TAMPA Scale of Kinesiophobia (TSK). Scores range from 1 (totally disagree) to 4 (totally agree). The final score can range between 11 and 44 points, with higher scores indicating greater perceived kinesiophobia.
Time frame: 48-72h after the intervention
Health-related Quality of Life
To assess health-related quality of life using the EuroQol-5D. Total score range from 1 (best health status) to 0 (death). The second part of the euroqol-5d is visual analogue scale that goes from 0 (worst state of health imaginable) to 100 (best state of health imaginable).
Time frame: Pre-intervention
Health-related Quality of Life
To assess health-related quality of life using the EuroQol-5D. Total score range from 1 (best health status) to 0 (death). The second part of the euroqol-5d is visual analogue scale that goes from 0 (worst state of health imaginable) to 100 (best state of health imaginable).
Time frame: 48-72h after the intervention
Algometry
To assess pain pressure threshold using algometer Force One FPIX 50. With the patient sitting in a comfortable position, the different bilateral points where sensitivity is to be evaluated will be marked on the skin. The chosen points are the nail phalanx of the thumb, the gracilis muscle at its insertion, the second rib, the supraspinatus muscle, and the middle portion of the trapezius. In the order described, pressure will be applied perpendicular to the point at a speed of 1 kg/sec until the patient stops the test when the sensation is no longer just "contact", but "discomfort". 3 repetitions will be done, leaving 1 minute between each of them and the average value will be calculated.
Time frame: Pre-intervention
Algometry
To assess pain pressure threshold using algometer Force One FPIX 50. With the patient sitting in a comfortable position, the different bilateral points where sensitivity is to be evaluated will be marked on the skin. The chosen points are the nail phalanx of the thumb, the gracilis muscle at its insertion, the second rib, the supraspinatus muscle, and the middle portion of the trapezius. In the order described, pressure will be applied perpendicular to the point at a speed of 1 kg/sec until the patient stops the test when the sensation is no longer just "contact", but "discomfort". 3 repetitions will be done, leaving 1 minute between each of them and the average value will be calculated.
Time frame: 48-72h after the intervention
Temporal summation
To assess temporal summation using algometer Force One FPIX 50. The pressure pain threshold will be evaluated in the flexor digitorum muscle in both forearms. The average of both measurements will be calculated. A series of 15 stimuli will be presented to one arm at an interstimulus interval of 3s and then to the other arm at an interstimulus interval of 5s, separated by a 30s interseries interval. After a short break, the series of stimuli will be repeated in reverse order. Patients will be instructed to provide numerical ratings of the magnitude of the sensation experienced during the first, fifth, tenth, and fifteenth period after repeated brief taps. They will be also asked to report on the magnitude of after-sensations present 15 and 60 s after the last stimulus in each series.
Time frame: Pre-intervention
Temporal summation
To assess temporal summation using algometer Force One FPIX 50. The pressure pain threshold will be evaluated in the flexor digitorum muscle in both forearms. The average of both measurements will be calculated. A series of 15 stimuli will be presented to one arm at an interstimulus interval of 3s and then to the other arm at an interstimulus interval of 5s, separated by a 30s interseries interval. After a short break, the series of stimuli will be repeated in reverse order. Patients will be instructed to provide numerical ratings of the magnitude of the sensation experienced during the first, fifth, tenth, and fifteenth period after repeated brief taps. They will be also asked to report on the magnitude of after-sensations present 15 and 60 s after the last stimulus in each series.
Time frame: 48-72h after the intervention
Chronic pain modulation
To assess pain modulation using algometer Force One FPIX 50. The pressure pain threshold will be evaluated in the tibialis anterior muscle and the deltoid muscle. Then the conditioning stimulus will be introduced. A clamp will be placed on the earlobe for 60 seconds. When pain VAS of the earlobe become more than 60 mm, pain pressure threshold will be evaluated again.
Time frame: Pre-intervention
Chronic pain modulation
To assess pain modulation using algometer Force One FPIX 50. The pressure pain threshold will be evaluated in the tibialis anterior muscle and the deltoid muscle. Then the conditioning stimulus will be introduced. A clamp will be placed on the earlobe for 60 seconds. When pain VAS of the earlobe become more than 60 mm, pain pressure threshold will be evaluated again.
Time frame: 48-72h after the intervention
Electromyography
To assess muscular activity using electromyography with Biosignalplux device (Research Kit Biosignalplux, PLUX Wireless Biosignal S.A). A functional task and flexion-relaxion fenomenon will be evaluated.
Time frame: Pre-intervention
Electromyography
To assess muscular activity using electromyography with Biosignalplux device (Research Kit Biosignalplux, PLUX Wireless Biosignal S.A). A functional task and flexion-relaxion fenomenon will be evaluated.
Time frame: 48-72h after the intervention
Central Sensitization
To identify when a patient's symptoms may be related to central sensitization using Central Sensitization Inventory (CSI). Responses are recorded for the frequency of each symptom on a Likert scale from 0 (never) to 4 (always), resulting in a total possible score of 100. Higher scores are associated with a higher degree of self-reported symptomatology.
Time frame: Pre-intervention
Disability
To assess disability using the Oswestry Disability Index (ODI). Total scores range from 0% (no limitation) to 100% (maximum functional limitation).
Time frame: Pre-intervention
Physical activity
To assess physical activity using the International Physical Activity Questionnaire. This measure assesses the types of intensity of physical activity and sitting time that people do as part of their daily lives are considered to estimate total physical activity in Metabolic Equivalent (MET)-min/week and time spent sitting.
Time frame: Pre-intervention