EVALUATION OF THE EFFECTIVENESS OF A PAIN NEUROSCIENCE EDUCATION CURRICULUM FOR PATIENTS WHO EXPERIENCE CHRONIC MUSCULOSKELETAL PAIN WITH CONCURRENT OPIOID DEPENDENCE

Background: Chronic musculoskeletal pain (CMP) is estimated to affect over 100 million adults annually and is targeted as an instigator of opioid dependence (OpD). Opioid medications are often the first response for patients suffering from CMP, but over 10 million people annually admit to misusing opioids. With the opioid epidemic, the healthcare system now has a population of patients who experience CMP with concurrent OpD. This persistent problem creates a perfect storm of fear of movement, low self-efficacy, and physical dysfunction. A critical component to chronic pain management is understanding how patients view their pain experience. Education may be one key that unlocks the door to functional improvement, but traditional education utilizes anatomical models that focus on tissue damage and peripheral sources of pain. Researchers have explored educating people about pain via Pain Neuroscience Education (PNE), a cognitive-based intervention that facilitates understanding of the biological processes underpinning the pain state. PNE may facilitate understanding pain experiences that are normal and expected, with the intent to reduce fear and increase self-efficacy. Utilization of PNE has not been researched in patients with CMP and concurrent OpD. Therefore, the purpose of this study was to evaluate the effectiveness of a PNE intervention with this specific cohort. We hypothesize that introduction of an adapted PNE curriculum, as a single intervention, which may facilitate change to kinesiophobia, pain self-efficacy, physical function and knowledge for patients with CMP and concurrent OpD. Materials and Methods: A retrospective chart review categorized the demographics and patient characteristics for 33 subjects who participated in an opioid-management program. A feasibility study was performed to determine acceptability and delivery of the PNE intervention. A final quasi-experimental study performed with 21 subjects; the experimental group (N=13) received the PNE curriculum and the control group (N=8) received general health education (GHE). Both groups received interventions in four, 15-minute sessions (once per month), one-on-one with the primary investigator. All subjects completed the same four patient-reported outcome measures at baseline, post-intervention and at a 90-day follow-up time point. Results: The retrospective chart review revealed categorized demographics, participant functional ability, and participation with physical therapy services. The results of the feasibility study revealed positive changes in kinesiophobia, pain self-efficacy and the knowledge of the PNE concepts; as well as the acceptability of the intervention. The quasi-experimental study results revealed statistically significant effects for Pain Self-Efficacy Questionnaire (PSEQ) and Neurophysiology of Pain Questionnaire (NPQ) on a paired samples t-test for the experimental group. Results also revealed no time by group interaction over the three time points (pre-, post-, and 90-day) for three of the four outcome measures (via repeated measures ANOVA). The differences between the two groups were displayed in the NPQ via two data collection points and the three data collection points with a statistically significant P-value (P=0.006 and P=0.009 respectively). The PSEQ demonstrated trends toward positive change over the two time points, but was not statistically significant (P=0.130). Conclusion: The chart review allowed categorization of patient characteristics and demographics. The feasibility study demonstrated that the PNE curriculum intervention was acceptable in terms of approach and understandability to two subjects. Results from the quasi-experimental study indicate a PNE curriculum is beneficial in assisting subjects to understand the neurophysiology behind their pain experience and amending self-efficacy regarding pain