Original article
Pain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education: A Double-Blind Randomized Controlled Trial

Presented to the World Confederation of Physical Therapy, June 2–6, 2007, Vancouver, Canada; the International Council on Physiotherapy in Psychiatry and Mental Health, February 27–29, 2008, Bergen University, Norway; the European Society of Physical and Rehabilitation Medicine, June 3–6, 2008, Bruges, Belgium; the International Federation of Orthopaedic Manipulative Therapists, June 9–13, 2008, Rotterdam, The Netherlands; and the European Federation of International Association for the Study of Pain Chapters, September 8–12, 2009, Lisbon, Portugal.
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Abstract

Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial.

Objective

To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome (CFS) and chronic widespread pain.

Design

Double-blind randomized controlled trial.

Setting

Specialized chronic fatigue clinic in university hospital.

Participants

A random sample of patients (N=48) with CFS patients (8 men, 40 women) experiencing chronic pain, randomly allocated to the control group (n=24) or experimental group (n=24). Two women in the experimental group did not complete the study because of practical issues (lack of time and restricted mobility).

Interventions

One individual pain physiology education session (experimental) or 1 pacing and self-management education session (control).

Main Outcome Measures

Algometry, the Neurophysiology of Pain Test, and questionnaires evaluating pain cognitions—the Pain Coping Inventory, the Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia–version CFS—were completed immediately before and immediately after the intervention.

Results

After the intervention, the experimental group demonstrated a significantly better understanding of the neurophysiology of pain (P<.001) and a reduction of the Pain Catastrophizing Scale subscale “ruminating” (P=.009) compared with controls. For these variables, moderate to large Cohen d effect sizes were revealed (.79–2.53).

Conclusions

A 30-minute educational session on pain physiology imparts a better understanding of pain and brings about less rumination in the short term. Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain, given the clinical relevance of inappropriate pain cognitions.

Section snippets

Design

An information leaflet was handed to patients intending to participate. When patients agreed to participate, they were asked to sign the informed consent form. The study protocol was approved by the ethical committee of the University Hospital Brussels.

Patients were randomly allocated to the experimental or the control group. Both the experimental (pain physiology) and the control (pacing and self-management) education involved one 30-minute 1-on-1 interactive information session. Immediately

Results

This study consisted of 48 patients with CFS, 8 men (16.7%) and 40 women (83.3%), who were randomly allocated to either an experimental group or a control group. In the experimental group, 2 women did not complete the study. One was pressed for time, and the other woman was not able to lie on her stomach (for pain threshold assessment of the calf and back) because of restricted mobility. The flow of participants through the study is presented in figure 1. Group characteristics are shown in

Discussion

After a 30-minute educational session on pain physiology, patients presented an increased understanding of pain and reported the intention to ruminate less compared with a control group.

Conclusions

We can conclude that patients with CFS are indeed able to increase their understanding of the neurophysiology of pain, because they scored much better on the Neurophysiology Pain Test after the pain physiology education. The pain physiology education has even immediate effects on ruminating (part of catastrophizing) about the pain. No therapy effect could be revealed for the pain thresholds. Pain physiology education can be seen as an efficient component of the biopsychosocial approach to

Acknowledgments

We are grateful to K. De Meirleir, MD, for diagnosing the study participants, to A. Farasyn, PhD, for kindly providing his expertise on pressure pain threshold assessment, and to Karen Wallman, PhD, for editing the article.

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    Supported by the Higher Institute of Physiotherapy, Department of Health Sciences, Artesis University College Antwerp, Belgium (grant no. G 807), the Faculty of Physical Education and Physiotherapy—Vrije Universiteit Brussel, Brussels, Belgium (OZR project OZ.R. 1234/MFYS Wer2), and a postdoctoral research fellowship of the Research Foundation Flanders—Fonds Wetenschappelijk Onderzoek (FWO).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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