Pain neurophysiology education improves pain beliefs in patients with chronic fatigue syndrome: A clinical experiment.

Background and Aims: The majority of Chronic Fatigue Syndrome (CFS) patients experience chronic pain and present abnormal pain cognitions. Educating chronic pain patients pain neurophysiology has been shown effective in improving pain cognitions, but nothing is known about the efficacy in CFS. We aimed at examining whether education on pain neurophysiology was capable of changing pain cognitions and pain thresholds in CFS patients with chronic widespread pain.
Methods: Forty-eight CFS-patients with chronic pain underwent pain threshold measurements and completed questionnaires evaluating their knowledge on pain neurophysiology, coping strategies, kinesiophobia and catastrophising. Patients were randomly assigned to the experimental group (n = 24), receiving individual education on pain neurophysiology, or to the control group (n = 24) receiving an individual session on activity management. Afterwards, questionnaires and assessments were repeated by a blind assessor.
Results: After the intervention, the experimental group demonstrated a significant better understanding of the neurophysiology of pain (p <.001), a reduction in the passive coping strategy "ruminating" (p = .011) and a decrease in the subscale "worrying" (p = .009) of the Pain Catastrophising Scale, compared to controls. For these three variables moderate to large Cohen's d effect sizes were revealed (0.76-2.53). An increase in the active coping strategy "distraction" (p = .021) was even so revealed.
Conclusion: Despite frequently reported concentration problems, CFS-patients are able to understand and learn the neurophysiology of pain, and this knowledge has immediate effects on pain cognitions. Reconceptualisation of pain by educating pain neurophysiology influences pain catastrophising and pain coping.