Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis

The aim was to examine the moderator effect of duration of PNE (total minutes) on changes in psychosocial variables after treatment in people with chronic musculoskeletal pain. PubMed/MEDLINE, Embase, Web of Science, Scopus and CINHAL databases were systematically searched from inception to 6 February 2023. A mixed-effects meta-regression was performed to determine the moderator effect of PNE duration. Twenty-three studies involving 2352 patients were included. Meta-analysis revealed a statistically significant effect in favour of PNE on pain neurophysiology knowledge, anxiety symptoms, catastrophizing and kinesiophobia. The total duration of PNE ranged from 40 to 720 min. A linear relationship was observed between longer duration of PNE (total minutes) and changes of psychosocial variables. In addition, a dose of 100, 200 and 400 min of PNE was estimated to exceed the minimum clinically important difference described in the literature for kinesiophobia (mean difference = –8.53 points), anxiety symptoms (mean difference = –1.88 points) and catastrophizing (mean difference = –7.17 points). Clinicians should provide a more tailored PNE to address psychosocial variables. •Pain education of 100 min may be the optimal duration to reduce kinesiophobia.•Pain education of 200 min may be the optimal duration to reduce anxiety symptoms.•Pain education of 400 min may be the optimal duration to reduce catastrophizing.•Clinicians may provide more tailored education to address these psychosocial variables.