Impact of a Biopsychosocial Pain Management Protocol on Central Sensitization and Fear Avoidance in Patients with Chronic Musculoskeletal Pain
Abstract
Objective: Chronic musculoskeletal pain (CMP) is a complex and persistent condition with a high prevalence that considerably affects physical, emotional, and social well-being. It is often influenced by central sensitization and fear-avoidance behaviours. This study aimed to evaluate the effects of a biopsychosocial pain management protocol on central sensitization and fear-avoidance behaviour in individuals with CMP.
Material and Methods: A randomized controlled trial was conducted with 127 participants, of whom 80 were randomly allocated via prospective random sampling into two groups: a biopsychosocial pain management group (n=40) and a regular physiotherapy group (n=40). Participants underwent an 8-week intervention and were assessed at baseline and post-intervention using the central sensitization inventory (CSI), fear-avoidance components scale (FACS), and numerical pain rating scale (NPRS). After two dropouts, statistical analyses were performed on 38 participants per group using paired and independent t-tests, Mann–Whitney U tests, and Wilcoxon signed-rank tests. Intention-to-treat analyses were also conducted, including all 40 participants. All analyses were performed using Jamovi software, version 2.3.28, with statistical significance set at p-value<0.05.
Results: Both groups showed significant improvements across all outcomes after 8 weeks. However, the biopsychosocial pain management group demonstrated significantly greater reductions in CSI (mean reduction=20.55 points, p-value<0.001) and FACS (mean reduction=25.92 points, p-value<0.001) compared to the regular physiotherapy group. Effect size analyses revealed large improvements in the biopsychosocial group, with Cohen’s d=1.41 for CSI and 0.71 for FACS.
Conclusion: Biopsychosocial pain management is more effective than regular physiotherapy alone in managing chronic musculoskeletal pain, particularly in reducing central sensitization and fear-avoidance behaviour. These findings support the integration of biopsychosocial approaches as a crucial component of multidisciplinary care for patients with CMP.
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