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Bottom line
Adding pain neuroscience education to exercise may improve pain, function, and pain catastrophizing in neck pain compared with exercise alone, but the evidence rests on only 4 small RCTs.
Preliminary evidencePublished
Evidence hierarchy
Study participants
Patients diagnosed with neck pain (trials published 2021-2022)
Study Summary
This meta-analysis pooled 4 randomized controlled trials (246 patients with neck pain) to compare pain neuroscience education combined with exercise against exercise alone. Adding pain neuroscience education was associated with significantly greater reductions in pain (VAS) immediately after treatment and at 3 months, as well as in functional disability and pain catastrophizing. The authors conclude that pain neuroscience education plus exercise appears effective for relieving neck pain, while cautioning that the evidence rests on only 4 small trials with notable heterogeneity for the 3-month pain outcome.
Key Findings
| Finding | Detail | Impact |
|---|---|---|
| Greater pain reduction immediately after treatment | Pain neuroscience education plus exercise lowered VAS after treatment versus exercise alone (MD = -1.12; 95% CI -1.51 to -0.73; P < .00001), with no heterogeneity between studies (I2 = 0%). | High |
| Pain reduction maintained at 3 months | VAS at 3 months also favored the combined intervention (MD = -1.24; 95% CI -2.26 to -0.22; P = .02), though with significant heterogeneity (I2 = 62%) and only 2 trials contributing. | Medium |
| Reduced functional disability | The combined intervention reduced the functional disability index versus exercise alone (MD = -1.22; 95% CI -1.46 to -0.97; P < .00001), reported across 3 studies. | High |
| Reduced pain catastrophizing | Pain catastrophizing scale scores fell more with the combined intervention (MD = -4.25; 95% CI -5.50 to -3.00; P < .00001), reported in 2 studies. | High |
| Included trials were judged high quality but few | All 4 RCTs scored 3 to 4 on the modified Jadad scale (high quality); however, only 4 trials with 246 total patients were available, and publication bias could not be assessed due to the limited number of studies. | Medium |
Pain neuroscience education plus exercise lowered VAS after treatment versus exercise alone (MD = -1.12; 95% CI -1.51 to -0.73; P < .00001), with no heterogeneity between studies (I2 = 0%).
VAS at 3 months also favored the combined intervention (MD = -1.24; 95% CI -2.26 to -0.22; P = .02), though with significant heterogeneity (I2 = 62%) and only 2 trials contributing.
The combined intervention reduced the functional disability index versus exercise alone (MD = -1.22; 95% CI -1.46 to -0.97; P < .00001), reported across 3 studies.
Pain catastrophizing scale scores fell more with the combined intervention (MD = -4.25; 95% CI -5.50 to -3.00; P < .00001), reported in 2 studies.
All 4 RCTs scored 3 to 4 on the modified Jadad scale (high quality); however, only 4 trials with 246 total patients were available, and publication bias could not be assessed due to the limited number of studies.
Strengths
- Followed PRISMA methodology with a systematic multi-database search (PubMed, EMBASE, Web of Science, EBSCO, Cochrane Library).
- Restricted to randomized controlled trials, all rated high quality (Jadad 3-4).
- No heterogeneity (I2 = 0%) for the primary post-treatment VAS outcome, strengthening that result.
- Assessed multiple clinically relevant domains: pain, function, and pain catastrophizing.
Limitations
- Only 4 RCTs with a total of 246 patients were included, limiting the strength and generalizability of conclusions.
- Significant heterogeneity (I2 = 62%) was present for the 3-month VAS outcome, and a sensitivity analysis could not be performed because only 2 trials contributed.
- Some outcomes were based on only 2 to 3 trials.
- Publication bias could not be evaluated owing to the small number of studies.
- Variation in pain severity/duration, treatment duration (6 weeks to 6 months), and patients' educational backgrounds may have affected results.
Key Takeaways for Patients
What This Means for You
- 01Learning how pain works in the brain and nervous system (pain neuroscience education) alongside doing exercises was linked to better neck pain relief than exercise on its own.
- 02The added benefit showed up not just in pain levels but also in everyday function and in how much people catastrophized or worried about their pain.
- 03These conclusions come from only 4 small studies, so they are encouraging but not yet definitive — more research is needed to be sure.
- 04Pain neuroscience education reframes pain as more than tissue damage, which may help reduce fear of movement and support staying active.