Background This study aimed to evaluate the additive effect of Pain Neuroscience Education (PNE), which addresses the biopsychosocial and neurophysiological foundations of pain, on conventional physiotherapy in myofascial pain syndrome (MPS). Methods Forty individuals with MPS aged between 18-50 years participated in the study. The participants were divided into two groups as study group (n=20) and control group (n=20). The control group received a conventional physiotherapy and rehabilitation program three times a week 6 weeks. In the Study group, PNE was given once a week for 6 weeks in addition to the conventional physiotherapy and rehabilitation programme. Short Form Mc-Gill Pain Questionnaire (SF-MPQ), Algometer, Pain Catastrophising Scale (PCS), Tampa Scale of Kinesiophobia (TSK) and Depression-Anxiety-Stress Scale (DASS), Pittsburg Sleep Quality Index (PSQI) and Myotonometry were used in the evaluation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
40
Transcutaneous electrical nerve stimulation (TENS); The negative electrode was placed on the trigger point and the positive electrode was placed on the insertion of the acromial tendon of the trapezius muscle. Conventional type TENS with a frequency of 50-100 Hz and a current duration of 100 μsec was applied for 20 minutes by adjusting the current intensity to the value that the patient could tolerate. US; Chattanooga® (Mexico) with 1.5 Watt/ cm² current intensity, 1 MHz frequency and continuous mode was applied to the right and left sides for 4 minutes each. It was performed by drawing circles on the trigger point and surrounding tissues with the US probe. HP; was applied for 20 minutes to the area covering the muscle with trigger point and surrounding tissues
An exercise programme consisting of stretching exercises for tense muscles which are effective in the formation of Myofascial Pain Syndrome (MPS) and trunk stabilisation exercises to provide deep postural muscle activation was applied. Abdominal hallowing exercise, shoulder bridge exercise, swimming exercise and stretching exercises were performed as 10 repetitions. In addition, scapular stabilisation exercises were also included in the programme because myofascial pain often leads to immobilisation. The 6-week exercise programme was planned to be progressively revised every 2 weeks. In this case, other extremities were included, new exercises were added, and progressive difficulty level was provided with the help of a medicine ball or resistance band. Patients were asked to perform this exercise programme, which was applied in the clinic, at home once a day for 10 repetitions. Whether the exercises were performed regularly at home was followed up with verbal feedback
Pain Neuroscience Education (PNE) was delivered to the study group through individual, face-to-face sessions focusing on pain neurophysiology. The content was based on the book Explain Pain and supported by a PowerPoint presentation incorporating metaphors, examples, and visual materials to enhance comprehension. Considering reduced attention span in individuals with chronic pain, PNE was provided once weekly for 6 weeks, with each session lasting approximately 15 minutes, resulting in a total duration of 90 minutes. Conventional physiotherapy interventions were initiated immediately after each PNE session. Patients were encouraged to ask questions during treatment to reinforce the educational content through their own pain experiences and to promote active engagement in subsequent sessions.
İstinye Üniversitesi
Istanbul, Merkez, Turkey (Türkiye)
Short Form Mc-Gill Pain Questionnaire (SF-MPQ)
Because pain is a multidimensional experience involving sensory and emotional components and is often difficult to describe, standardized pain assessment tools are essential in clinical practice. Due to the length and time required to complete the McGill Pain Questionnaire, pain was assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), developed by Melzack in 1987. The SF-MPQ consists of three sections. The first section includes 15 pain descriptors (11 sensory and 4 affective), each scored from 0 (none) to 3 (severe), providing total, sensory, and affective pain scores. The second section assesses overall pain intensity using a Likert-type scale ranging from 0 (no pain) to 5 (unbearable pain). The third section evaluates current pain intensity using a 10 cm Visual Analog Scale, scored from 0 (no pain) to 10 (severe pain).
Time frame: Baseline and end of Week 6
Pressure Pain Threshold Assessment
Pressure pain threshold is explained as the minimum amount of pressure measured at the first moment when the applied pressure sensation turns into pain. BASELINE® (USA) brand algometer, which can measure the pressure pain thresholds of trigger points, was used in the study. The pressure value is obtained by pressing a dynamic metal piston with a round disc with a surface area of 1 cm² at its tip to the relevant area. In our study, the pressure pain threshold of the sternocleidomastoid (SCM), upper trapezius (UT), levator scapula (LS), pectoralis major (PM) muscles, which are specified as overstrained muscle groups in the definition of 'Upper Cross Syndrome'
Time frame: Baseline and end of Week 6
Pain Catastrophising Scale (PCS)
It was developed to determine the thoughts and feelings of patients about pain when they experience pain. The scale, which consists of three sub-sections as magnification, rumination and helplessness, has 13 items in total. The total score varies between 0 and 52. A high total score means that patients have a high level of catastrophising pain.
Time frame: Baseline and end of Week 6
Tampa Scale of Kinesiophobia (TSK)
The Tampa Kinesiophobia Scale is a 17-item scale designed to assess the fear of re-injury or pain with movement. Each item of the TSK is answered using a scoring method consisting of 4 values. High scores indicate that the person has high kinesiophobia.
Time frame: Baseline and end of Week 6
Depression Anxiety Stress Scale (DASS)
The DASS is the 21-item short version of the original 42-item scale designed to evaluate individuals' levels of depression, anxiety, and stress. This version consists of three subscales-depression, anxiety, and stress-each comprising seven items. All items are rated on a 4-point Likert scale (0 = not suitable at all, 1 = somewhat suitable, 2 = generally suitable, and 3 = completely suitable). Scores for each subscale are calculated by summing the responses to the relevant seven items, resulting in a raw score between 0 and 21. For consistency with the original 42-item form, subscale scores are multiplied by two, with higher scores reflecting greater severity of depressive, anxious, or stress-related symptoms
Time frame: Baseline and end of Week 6
Pittsburgh Sleep Quality Index (PSQI)
Pittsburg Sleep Quality Index is a 24-question sleep questionnaire used to evaluate the sleep quality of individuals in the last one month period. The questions answered by the person consist of 7 sub-sections. A total score above 5 means poor sleep quality.
Time frame: Baseline and end of Week 6
Myotonometric Evaluation
MyotonPRO® (Estonia) is a noninvasive digital device used to objectively assess the mechanical properties of muscles. A brief (15 ms) and low-intensity (0.58 N) mechanical oscillation is applied perpendicular to the skin via the probe, which also records the tissue's response. Muscle response reflects the viscoelastic properties of the tissue, including oscillation frequency (Hz), stiffness (N/m), and elasticity (logarithmic decrement). Oscillation frequency represents resting muscle tone, elasticity indicates the muscle's ability to return to its original shape after deformation, and stiffness reflects resistance to an external force. Using MyotonPRO®, muscle properties of the sternocleidomastoid, upper trapezius, and pectoralis major muscles associated with Upper Cross Syndrome were evaluated.
Time frame: Baseline and end of Week 6
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