• Anneleen Malfliet, Jeroen Kregel, Mira Meeus, Nathalie Roussel, Lieven Danneels, Barbara Cagnie, Mieke Dolphens, and Jo Nijs.
• Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Medical Campus Jette, Building F-Kine, Laarbeeklaan 103, BE-1090 Brussels, Belgium; Pain in Motion International Research Group; Research Foundation Flanders (FWO), Brussels, Belgium; and Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Brussels, Belgium.
• Phys Ther. 2018 May 1; 98 (5): 357-368.

BackgroundAvailable evidence favors the use of pain neuroscience education (PNE) in patients with chronic pain. However, PNE trials are often limited to small sample sizes and, despite the current digital era, the effects of blended-learning PNE (ie, the combination of online digital media with traditional educational methods) have not yet been investigated.ObjectiveThe study objective was to examine whether blended-learning PNE is able to improve disability, catastrophizing, kinesiophobia, and illness perceptions.DesignThis study was a 2-center, triple-blind randomized controlled trial (participants, statistician, and outcome assessor were masked).SettingThe study took place at university hospitals in Ghent and Brussels, Belgium.ParticipantsParticipants were 120 people with nonspecific chronic spinal pain (ie, chronic neck pain and low back pain).InterventionThe intervention was 3 sessions of PNE or biomedically focused back/neck school education (addressing spinal anatomy and physiology).MeasurementsMeasurements were self-report questionnaires (Pain Disability Index, Pain Catastrophizing Scale, Tampa Scale for Kinesiophobia, Illness Perception Questionnaire, and Pain Vigilance and Awareness Questionnaire).ResultsNone of the treatment groups showed a significant change in the perceived disability (Pain Disability Index) due to pain (mean group difference posteducation: 1.84; 95% CI = -2.80 to 6.47). Significant interaction effects were seen for kinesiophobia and several subscales of the Illness Perception Questionnaire, including negative consequences, cyclical time line, and acute/chronic time line. In-depth analysis revealed that only in the PNE group were these outcomes significantly improved (9% to 17% improvement; 0.37 ≤ Cohen d ≥ 0.86).LimitationsEffect sizes are small to moderate, which might raise the concern of limited clinical utility; however, changes in kinesiophobia exceed the minimal detectable difference. PNE should not be used as the sole treatment modality but should be combined with other treatment strategies.ConclusionsBlended-learning PNE was able to improve kinesiophobia and illness perceptions in participants with chronic spinal pain. As effect sizes remained small to medium, PNE should not be used as a sole treatment but rather should be used as a key element within a comprehensive active rehabilitation program. Future studies should compare the effects of blended-learning PNE with offline PNE and should consider cost-effectiveness.

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