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Explain Pain cited evidence – ref#5

Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain

Moseley, G.L. (2004), Eur J Pain 8: 39-45.

Oh look! Pain cognitions again.  How you understand pain. What you understand it to be, how it works in the body, all that jazz.

Again, it’s only an abstract. This one is a bargain at $12 USD, or around $18 Aussies.

This one sounds a lot like the first study, to tell the truth. Almost exactly the same.

Here’s the aims:

Aims: To determine if a relationship exists between change in pain cognitions and change in physical performance when chronic LBP patients participate in a single one-to-one education intervention during which they have no opportunity to be active.

Sounds good, finally, he wants to look at if JUST pain education induces a change in physical performance. NO exercise program. Good.

Methods: In a quasi-experiment using a convenience sample, moderately disabled chronic LBP patients (n=121) participated in a one-to-one education session about either lumbar spine physiology or pain physiology. Multiple regression analysis evaluated the relationship between change in pain cognitions measured by the survey of pain attitudes (SOPA) and the pain catastrophising scale (PCS) and change in physical performance, measured by the straight leg raise (SLR) and standing forward bending range.

WTF is a ‘quasi-experiment’?  Is he saying this was kinda slapped together and won’t stand up in court? 

Also, WTF is ‘moderately disabled’?  Shouldn’t you define that? Because I’m going to assume that moderately disabled means moderate pain. I think that’s a fair assumption. So again, this study is not looking at people with severe pain, and not treating severe pain, but ‘moderate’ pain. And as stated many hundreds of times previously, treating mild, moderate and/or severe pain are very different animals.   Point is, I am just assuming this is ‘moderate pain’.  I wouldn’t have to assume if he’d included a quick definition.  Qualified the information.  But hey, what do I know. Do I even science???  At least this time he tells me how many patients – 121. Small sample. But its better than 10 people or something.

Anyway, these 121 people were given the Survey of Pain attitudes and pain catastrophising scale. And were give the straight leg raise and forward bending test to measure their physical range.  Then they were given one to one education on pain.  Then they took the tests again. 


There was a strong relationship between cognitive change and change in straight leg raise (SLR) and forward bending (r=0.88 and 0.79, respectively, P<0.01), mostly explained by change in the conviction that pain means tissue damage and catastrophising.

Ok, that’s impressive. There was correlation.  Strong correlation. But.  Correlation does not equal causation, i.e. we can’t say that the pain education caused the improved results.  And did the results persist? Did they check back in a few weeks to see if the correlation was still there? No?  ok, whatever.

The conclusion was:

Change in pain cognitions is associated with change in physical performance, even when there is no opportunity to be physically active. Unhelpful pain cognitions should be considered when interpreting physical assessments.

Pretty good. I respect this. It shows strong correlation, he’s not trying to claim causation. EXCEPT in the book.  Where he DOES claim causation.  And uses this study as evidence of such.  But whatever.

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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