Pain Neuroscience Education and Manual Therapy

Louw A; NIjls J, Puentedura EJ. A clinical perspective on a pain science education approach to manual therapy. JMMT: 2017

  • Pain Neuroscience education (PNE) is a strategy used to teach people in pain more about the neurophysiological and neurobiological processes involved in their pain experience, especially chronic pain.

  • PNE has been shown in the research to be effective in several conditions including chronic low back pain, fibromyalgia, whiplash-associated disorders, and before lumbar surgery.

  • PNE is often regarded as a “hands-off” educational approach addressing patient misbeliefs about pain and the health of their tissues, while manual therapy often employs biomechanical and pathoanatomical models for its approach, often with a focus on specific tissue source of pain or dysfunction.

  • The authors believe that the PNE can be integrated within a modern manual therapy approach

  • Evidence as to where PNE fits into a manual therapy approach comes in a RCT where manual therapists performed a grade II Central PA mobilization to the lumbar spine in pts with chronic LBP. In one group, a PNE education model was employed and in the second group, a traditional biomechanical explanation was given. SLR ROM post intervention showed a significant difference in favor of the PNE group compared to the traditional education group.

  • It is important, therefore, that when applying MT to pts, especially chronic pain patients, that the rationale presented be emphasized as a transient technique to help gain some movement and facilitate pain relief through endogenous analgesic mechanisms.