L’efficacia dell’educazione terapeutica come strumento riabilitativo per il paziente con dolore cronico muscoloscheletrico di natura non maligna: revisione della letteratura

Abstract

Pain is the most powerful motivating force that guides treatment-seeking behaviors in patients. This applies especially to those who are suffering from chronic pain, whose treatment is a difficult challenge for health professionals. Objective. To evaluate the effectiveness of Therapeutic Education in the treatment of pain and disability, and the effects on the psycological outcomes in patients with chronic musculoskeletal pain. The analysed educational intervention namely “Pain Neurophysiology Education”, is a promising tool according to results of the neuroscientific investigation in pain pathophysiology, during the last two decades. Methods. Literature search was conducted on PubMed, Pedro and Cochrane Library. All experimental studies including reviews, randomized controlled trials (RCTs), non-randomized clinical trials, and evaluating the effect of Pain Neurophysiology Education (PNE) on pain, disability, anxiety, and stress in chronic musculoskeletal pain disorders, (e.g. fibromyalgia and chronic fatigue syndrome) were considered for inclusion. Additional limitations: studies publishedin English or French within the last 10 years, adult patients (18-65 years). No limitations were set on specific outcome measures of pain, disability, anxiety, and stress. Data were extracted using the participants’ interventions, comparisons, and outcomes (PICO) approach. Methodological quality was assessed following actual scientific literature guidelines: the “Oxford Centre for Evidence-based Medicine Levels of Evidence” to assess the level of evidence, the CASP to assess methodological quality properly. Results. This review includes 8 studies RCTs and 2 Systematic Reviews, involving 951 subjects totally. Most studies were of good quality (at least 7 out of 10), with no studies rated as poor or fair. Heterogeneity across the studies with respect to participants, evaluated interventions, and outcome measures used, allowed just a narrative synthesis of results based on effect size. Conclusions. Despite the few studies and some methodological critiques, there is compelling evidence that rehabilitative intervention that includes the Therapeutic Education, in particular PNE, can have a positive effect on pain, disability, catastrophization, and physical function. The PNE effectiveness may be due to the shift of the focus from tissue damage to central processing of nociception, with the aim to increase the patient’s awareness of the no-correlation between nociception and pain. Therefore it could be conceived as an intervention that can decrease both the alertness and, as a consequence, the patient’s perception of pain.