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Explain Pain cited evidence – ref#2

Combined physiotherapy and education is effective for chronic low back pain. A randomised controlled trial

Moseley, G.L. (2002), Aus J Physioth 48: 297-302.

https://pubmed.ncbi.nlm.nih.gov/12443524/

Yay. I was wrong. this one IS available, not all of them are behind paywalls. Will have to read this. Cost is FREE

full pdf

Whelp. The title says it all for this one.  I don’t really need to go any further…this is so effing common.  “Combined physiotherapy and education” means they got both physiotherapy AND education. Therefore, this does NOT prove that the ‘education’ part is reducing pain! 

It’s not proving that “education” is doing anything at all!  

I’ve read so many studies like this.  They always include education with exercise (or some other therapy) and then draw the flawed conclusion that the education was the factor that incited pain relief! Sorry to be a stickler for the truth, but you can’t do that!

And here we go again. This study CANNOT prove that PNE reduces pain, because they’re getting physiotherapy as well as education. The two are not separated, they get both or none. And the physiotherapy (exercise) component is far more likely to be facilitating any pain relief!

But fine. I’ll read it. 

Manual therapy, exercise and education target distinct aspects of chronic low back pain and probably have distinct effects. This study aimed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies. By concealed randomisation, 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners. The dependent variables of interest were pain and disability. Assessors were blind to treatment group. Outcome data from 49 subjects (86%) showed a significant treatment effect. The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale (95% CI 0.7 to 2.3) and 3.9 points on the 18-point Roland Morris Disability Questionnaire (95% CI 2 to 5.8), respectively. The number needed to treat in order to gain a clinically meaningful change was 3 (95% CI 3 to 8) for pain, and 2 (95% CI 2 to 5) for disability. A treatment effect was maintained at one-year follow-up. The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients.

So there you go.  Yes, the patients got physiotherapy that included exercise, manual therapy and education.  And the control group got usual GP care.  That is, not physiotherapy. 

This study proves absolutely NOTIHNG about pain neuroscience education. 

Why the F didn’t they do a study that compared physiotherapy– education OR manual therapy OR exercise and see which was most effective?  If this aimed to prove that education is effective at reducing chronic pain, wouldn’t they need to test the education part on its own?  Isn’t that logical? Otherwise, the study just shows that education and manual therapy and exercise, when used together, are better at reducing chronic pain than usual GP care.

Nothing earth shattering here. And nothing that supports Explain Pain as a therapy in its own right.

Also, 57 people were included in this study.  Hardly ROBUST evidence!  This is a tiny study that doesn’t show a thing.  Definitely not something I’d base a book and a worldwide PR campaign on.  

So we’re two for two, both the first studies do NOT show any evidence that Explain Pain reduces pain and disability.

This is really shitting me already.  It’s the same stuff, over and over. And now, for the first time, I’m actually looking at Lorimer’s evidence and its worse than I thought.  Tiny studies, none of which separate pain education out and measure its treatment effect, in and of itself. YET lorimer claims over and over that just the act of learning pain neuroscience WILL reduce pain.

Frankly, that’s a marketing tactic. Repeat something often enough and people will believe it. Just be authoritative and ‘authentic’ and people will believe you.  It’s what politicians do all the time.  And criminals:  Deny, deny, deny!  With Moseley and Butler its ‘promote, promote promote!’. Doesn’t matter that the science doesn’t measure up. Just keep telling the lie, people will believe it.

And it’s true, people did believe it. To the great detriment of people living with severe, daily pain.

Sadly, this study was also cited by 90 other studies. WTF?

PsychosomaticAddict
Author: PsychosomaticAddict

Chronic Pain Patient Advocate. Pain Coach. Patient. Living with High Impact Chronic Pain and advocating for proper pain treatment, including opioids where appropriate. Busting the myths. Exposing the actual science.

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