A Randomized Trial to Evaluate the Efficacy of a Pain Neuroscience Education Program on Executive Function and Pain Intensity in Women With Fibromyalgia.

OBJECTIVE

To evaluate the efficacy of a brief, structured pain neuroscience education (PNE) program on executive function and pain intensity in women with fibromyalgia (FM).

DESIGN

Randomized clinical trial.

SETTING

Rheumatology and pain clinics in Mexico and Colombia.

PARTICIPANTS

Sixty-two women aged 40-60 years diagnosed with FM according to American College of Rheumatology 2010 criteria.

INTERVENTIONS: Participants were randomly divided to either PNE plus usual care or usual care alone. The intervention consisted of ten 40-45-minute online PNE sessions delivered over 5 weeks.

MAIN OUTCOME MEASURES: Coprimary outcomes were pain intensity, assessed with the visual analog scale; FM impact, assessed with the Fibromyalgia Impact Questionnaire-Revised; and executive function (multidimensional domain), assessed with 4 tasks: the Wisconsin Card Sorting Test (cognitive flexibility), the Simon Task (inhibition), the Corsi Block-Tapping Task (visuospatial working-memory capacity), and the Digit Span Forward Task (phonological working-memory capacity). Secondary outcomes were central sensitization (Central Sensitization Inventory), pain catastrophizing (Pain Catastrophizing Scale), kinesiophobia (Tampa Scale for Kinesiophobia-11), depressive symptoms (Beck Depression Inventory-II), and anxiety (State-Trait Anxiety Inventory).

RESULTS

Compared with controls, the PNE group showed greater reductions in pain (-3.24; P=.001), FM impact (-15.14; P=.001), central sensitization (-22.36; P=.001), catastrophizing (-7.24; P=.020), and kinesiophobia (-8.68; P=.001). Depressive symptoms also improved (-6.78; P=.023). Trait anxiety decreased more in the control group (P=.001). Executive-function effects were domain specific: phonological working memory (Digit Span Forward) improved significantly (P=.007), whereas no significant effects were observed for visuospatial working memory, cognitive flexibility, or inhibition after multiplicity adjustment.

CONCLUSION

PNE plus usual care significantly improves pain, functional impact, central sensitization, catastrophizing, kinesiophobia, and phonological working memory in FM. Cognitive effects were selective (no improvement in flexibility, inhibition, or visuospatial working memory) and mood outcomes were mixed.