This is a pilot study to determine if neuroscience education is acceptable to adults over 65
and if it can have an impact on pain, pain beliefs and gait speed
Background: Health care professionals commonly provide education to patients who are in
pain. Traditionally, this education has focused on pathoantaomical aspects of the patient's
condition.(1,2) Despite the popularity of this type of education the evidence has indicated
that it either has little effect (2-4) or in some cases can have a negative effect on pain
and disability.(3,5-7) In contrast, therapeutic neuroscience education (TNE) directly
addresses cognitions about pain by teaching patients basic pain physiology and addressing
abnormal pain beliefs (e.g., pain=harm). TNE has been shown to produce positive changes in
pain beliefs, including a reduction in pain catastrophizing, and improvements in both pain
levels and pain-related disability. (2,3,8) To date, research on the impact of TNE has
focused on working-aged adults. Pain however, is highly prevalent among the older adult
population, leading to activity limitation and pain-related disability.(4-7) The purpose of
this project is to determine whether older adults are receptive toTNE, if TNE can have an
impact on the gait speed of older adults and if TNE can have an impact on pain beliefs.
Methods: This will be a single group, uncontoled pilot study of 15-20 adults aged 65 years
and older who report low back or lower extremity pain. Subjects will be recurited from
physician offices and the community via flyers and word of mouth. Subjects will be screened
for eligibility and informed consent will be obtained. Inclusion criterion will include age
over 65, self-reported back and/or lower extermity pain present on most days for at least
three months, be independent with ambulation (with or without and assistive device) and
English speaking. Exclusion criteria include cancer-related pain, recent (within 6 months)
surgery on the back or lower extremities affecting mobility, current ongoing treatment by
another healthcare professional for low back or lower extremity pain (including physical
therapy, chiropractic or massage) or other diagnoses that impact mobility or rusult in
Upon enrollment in the study each subject will complete intake questionnaires (basic
demographic information, the Tampa Scale of Kinesiophobia (TSK), Pain Disability Index
(PDI), and Resilience Scale( RS), and one physical performance measure (Gait Speed,
preferred and maximal).
The educational material will be delivered in two, one on one, meetings for a total time of
approximately ninety minutes. The first meeting will last about one hour and all of the
educational content will be delivered in this session. A supplemental handout (reference),
which will highlight the concepts covered in the presentation, will be given to each
subject. The second educational session will serve as a review of the material covered in
the first meeting and described in the supplemental materials. During this session subjects
will be encourage to ask questions and get clarification about any of the covered topics
which are unclear. At the conclusion of the second session the surveys initially
administered will be repeated (TKS, PDI, RS), the gait speed test will be repeated and a
brief survey about the education will be administered.
1. Butler D, Moseley L, eds. Explain pain. Australia: NOI Group Publishing; 2003.
2. Brox JI, Storheim K, Grotle M, Tveito TH, Indahl A, Eriksen HR. Systematic review of
back schools, brief education, and fear-avoidance training for chronic low back pain.
Spine J. 2008;8(6):948-958.
3. Maier-Riehle B, Harter M. The effects of back schools--a meta-analysis. Int J Rehabil
4. Koes BW, van Tulder MW, van der Windt WM, Bouter LM. The efficacy of back schools: A
review of randomized clinical trials. J Clin Epidemiol. 1994;47(8):851-862.
5. Nachemson AL. Newest knowledge of low back pain. A critical look. Clin Orthop Relat
6. Poiraudeau S, Rannou F, Baron G, et al. Fear-avoidance beliefs about back pain in
patients with subacute low back pain. Pain. 2006;124(3):305-311.
7. Hirsch MS, Liebert RM. The physical and psychological experience of pain: The effects
of labeling and cold pressor temperature on three pain measures in college women. Pain.
8. Louw A, Diener I, Butler DS, Puentedura EJ. The effect of neuroscience education on
pain, disability, anxiety, and stress in chronic musculoskeletal pain. Arch Phys Med
- over 65 years old, have low back and/or lower extremity pain present on most days for
at least three months, be independent with ambulation (with or without assistive
device) and English speaking.
- cancer related pain, recent surgery (within 6 months) on the back or lower
extremities affecting mobility, current ongoing treatment by another healthcare
professional for low back or lower extremity pain (including physical therapy,
chiropractic or massage) or the presence of other diagnoses that impact mobility or
result in cognitive limitations.