Pain Education for Osteoarthritis

(PNE Trial)

Overseen By Erfan Shafiee, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Lisa Carlesso

Disqualifiers: Prior PNE, Severe vision issues, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores two educational methods for managing pain in people with knee osteoarthritis. One method provides standard education about the disease, while the other, pain neuroscience education (PNE), focuses on understanding pain and its management. Researchers aim to assess how these approaches affect stress responses and emotional well-being. The trial suits adults diagnosed with knee osteoarthritis who experience activity-related joint pain and minimal morning stiffness. As an unphased trial, it offers participants the chance to contribute to innovative educational strategies that could enhance pain management for many.

Do I have to stop taking my current medications for the trial?

The trial protocol does not specify whether you need to stop taking your current medications.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It focuses on educational approaches for managing knee osteoarthritis pain.

What prior data suggests that these educational methods are safe for older adults with knee osteoarthritis?

Research shows that Pain Neuroscience Education (PNE) is generally well-tolerated by people with knee osteoarthritis. Studies have found that PNE, when combined with exercises, reduces the fear of pain without causing serious side effects. Participants in these studies reported feeling less anxious about their pain, indicating the safety of this education method.

The available research reports no serious harmful effects from using PNE. This suggests that participants usually do not experience negative effects from this type of education. Thus, PNE appears to be a safe option for those considering joining a study involving pain management education. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Pain Neuroscience Education (PNE) approach for osteoarthritis because it shifts the focus from the structural issues in the knee to how pain is processed in the brain. Unlike standard treatments that often emphasize the wear and tear of joints, PNE uses positive language to help patients understand that pain can be managed by staying active and focusing on physical function. This method could empower patients to take an active role in their pain management, potentially improving quality of life without relying heavily on medications or invasive procedures.

What evidence suggests that this trial's educational approaches could be effective for knee osteoarthritis?

Research has shown that Pain Neuroscience Education (PNE), an educational approach in this trial, can help people with osteoarthritis experience less pain and improve mobility. Some studies suggest that PNE lowers pain levels, reduces fear of movement, and lessens negative thoughts about pain. These improvements may lead to increased physical activity and reduced disability. Specifically, one study found that combining PNE with exercise reduced worry about pain and improved specific patient outcomes. Overall, PNE educates patients on how the brain affects pain, helping them feel more in control and encouraging them to stay active. ^{1 2 3 6 7}

Who Is on the Research Team?

Lisa Carlesso, PhD

Principal Investigator

McMaster University

Are You a Good Fit for This Trial?

This trial is for adults over 55 with knee osteoarthritis, experiencing joint pain related to activity and minimal morning stiffness. It's aimed at community-dwelling individuals who either have a diagnosis of knee OA or meet the NICE criteria for it.

Inclusion Criteria

I have been diagnosed with knee osteoarthritis.

I experience joint pain when I move.

I am 55 years old or older.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive either pain neuroscience education or standard biomedical education, followed by a talk-aloud session

1 week

1 visit (in-person)

Follow-up

Participants are monitored for physiological and self-reported outcomes post-intervention

1 week

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Pain Neuroscience Education
• Standard Pain Education

Trial Overview The study compares two educational methods: standard biomedical education about osteoarthritis and pain neuroscience education (PNE), which addresses the complexity of pain. The focus is on how these affect physiological responses to pain in the nervous system.

How Is the Trial Designed?

Group I: Pain neuroscience education Experimental Treatment 1 Intervention

The educational content will be presented to the participants at a computer station in the format of a website to navigate to simulate the experience and information that they may come across while browsing the internet for information about knee OA. The content will include 4 components, regardless of the education type. These components include knee osteoarthritis (OA)-related images, facts and myths, disease related concepts, and patient-doctor statements. The distinction between the two educational approaches lies in how information is presented. PNE focuses more on the neurophysiology of pain and approaches it from the perspective that knee OA pain is manageable, using neutral to positive language and emphasizes the importance of physical function and staying active. After the educational content is delivered, the participants will be shown the content again and will be asked to talk aloud about each page that they were shown.

Group II: Biomedical education Active Control 1 Intervention

In Standard Pain Education, the emphasis is on the structural pathology of knee OA and the outdated but common understanding of the disease process as a degenerative one, potentially conveying negative and threatening language. After the educational content is delivered, the participants will be shown the content again and will be asked to talk aloud about each page that they were shown.

Who Is Running the Clinical Trial?

Lisa Carlesso

Lead Sponsor

Trials

1

Recruited

40+

Published Research Related to This Trial

Pain neuroscience education (PNE) combined with other treatments, particularly exercise-based interventions, appears to enhance clinical outcomes for patients with chronic musculoskeletal pain (CMP), especially in reducing psychosocial influences.

However, PNE used alone does not show significant improvements in pain intensity or disability, indicating that its effectiveness may depend on being part of a multimodal treatment approach.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pain neuroscience education in patients with chronic musculoskeletal pain: an umbrella review. Cuenca-Martínez, F., Suso-Martí, L., Calatayud, J., et al.[2023]

A single lecture on Pain Neuroscience Education (PNE) significantly improved the understanding of chronic pain among Doctor of Physical Therapy (DPT) students, as shown by increased scores on the Neuroscience Pain Questionnaire (NPQ) and Health Care Providers Pain and Impairment Relationship Scale (HC-Pairs).

DPT students not only retained this knowledge for at least 6 months but also demonstrated the ability to apply their understanding of chronic pain in clinical scenarios, indicating the effectiveness of PNE as a teaching tool.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pain Neuroscience Education for Physical Therapy Students. Talmage, H., Wilmarth, H., Guffey, JS.[2021]

Individuals with persistent pain tend to express more negative attitudes towards pain neuroscience education (PNE) statements compared to pain-free controls, indicating a potential barrier to the acceptance of PNE concepts in this group.

Healthcare professionals, including those with persistent pain, generally show less negativity towards PNE statements, suggesting that their training may influence their perceptions of pain education differently than those without a healthcare background.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Weisman, A., Yona, T., Gottlieb, U., et al.[2022]

The study involving 89 healthy children showed that watching a pain educational video significantly increased their pain knowledge and pain threshold compared to a control group, indicating that PNE can enhance understanding of pain in children.

However, the video did not significantly reduce experienced pain intensity, pain-related fear, or catastrophic worry, suggesting that while PNE can improve knowledge and thresholds, its effects on emotional responses to pain may vary based on age and sex.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of a pain educational video intervention upon child pain-related outcomes: A randomized controlled study. Rheel, E., Ickmans, K., Wauters, A., et al.[2021]

A 30-minute pain neuroscience education (PNE) lecture significantly improved pain knowledge among 133 middle school students, with scores increasing from 3.83 to 7.90 on a neurophysiology of pain questionnaire, indicating a large effect size.

The lecture also positively shifted students' beliefs about pain, particularly in understanding that the brain plays a crucial role in pain perception, demonstrating the potential of PNE to influence pain-related beliefs in younger populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can pain beliefs change in middle school students? A study of the effectiveness of pain neuroscience education. Louw, A., Podalak, J., Zimney, K., et al.[2018]

Blended-learning pain neuroscience education (PNE) improved kinesiophobia and illness perceptions in 120 participants with chronic spinal pain, showing significant improvements in specific areas like negative consequences and time perceptions related to illness.

Despite these positive outcomes, the overall effect sizes were small to moderate, suggesting that PNE should be part of a broader rehabilitation strategy rather than a standalone treatment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Blended-Learning Pain Neuroscience Education for People With Chronic Spinal Pain: Randomized Controlled Multicenter Trial. Malfliet, A., Kregel, J., Meeus, M., et al.[2019]

Pain neuroscience education (PNE) significantly reduced pain catastrophization and pain intensity in patients with knee osteoarthritis after 2 weeks, compared to conventional physiotherapy alone, based on a study of 70 participants.

While PNE improved pain-related outcomes, it did not show a significant difference in patient-specific function compared to the control group, indicating that while PNE is effective for pain management, it may not directly enhance functional abilities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Pain Neuroscience Education with Conventional Physiotherapy via Telerehabilitation on Pain Catastrophizing and Function in Patients with Osteoarthritis Knee: A Randomized Controlled Trial. Supe, HM., Mungikar, SS., Katage, GA., et al.[2023]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8909562/

Effectiveness of Interventions Based on Pain Neuroscience ... Objective: To determine the results of cognitive educational interventions for pain management and psychosocial variables in adults with OA.

2. arthritis-research.biomedcentral.com arthritis-research.biomedcentral.com/articles/10.1186/s13075-023-03079-7

Examining the influence of pain neuroscience education ... This study aimed to investigate the effect of pain neuroscience education (PNE) followed by Pilates exercises (PEs) in participants with knee OA, compared to ...

3. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1360859224001955

Efficacy of preoperative pain neuroscience education in ... To evaluate the efficacy of preoperative pain neuroscience education (PNE) on pain intensity, kinesiophobia, catastrophizing, and disability in individuals ...

4. jamanetwork.com jamanetwork.com/journals/jamanetworkopen/fullarticle/2819252

Exercise and Pain Neuroscience Education for Patients ... Findings from this study suggest that neuromuscular exercise and pain neuroscience education do not provide superior pain and function outcomes.

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10664057/

Effect of Pain Neuroscience Education with Conventional ... The results suggest that adding a program of PNE to conventional physiotherapy exercises led to a greater reduction in pain catastrophization, patient-specific ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10078781/

Exercise physiologists use of pain neuroscience education for ... To explore how Australian exercise physiologists (EPs) utilise pain neuroscience education (PNE) in their management of patients with knee osteoarthritis.

7. centerwatch.com centerwatch.com/clinical-trials/listings/NCT05730829/pain-informed-movement-for-people-with-knee-osteoarthritis

Pain Informed Movement for People With Knee Osteoarthritis The goal of this clinical trial is to compare a pain informed movement program to standard neuromuscular exercise in people with knee ...