***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : The aim of this study was to compare the effectiveness of a combination of aquatic exercise and pain neurophysiology education with aquatic exercise alone in chronic low back pain patients . Design : Single-blind r and omized controlled trial . Setting : Outpatient clinic . Subjects : Sixty-two chronic low back pain patients were r and omly allocated to receive aquatic exercise and pain neurophysiology education ( n = 30 ) or aquatic exercise alone ( n = 32 ) . Interventions : Twelve sessions of a 6-week aquatic exercise programme preceded by 2 sessions of pain neurophysiology education . Controls received only 12 sessions of the 6-week aquatic exercise programme . Main measures : The primary outcomes were pain intensity ( Visual Analogue Scale ) and functional disability ( Quebec Back Pain Disability Scale ) at the baseline , 6 weeks after the beginning of the aquatic exercise programme and at the 3 months follow-up . Secondary outcome was kinesiophobia ( Tampa Scale of Kinesiophobia ) . Results : Fifty-five participants completed the study . Analysis using mixed-model ANOVA revealed a significant treatment condition interaction on pain intensity at the 3 months follow-up , favoring the education group ( mean SD change : −25.4± 26.7 vs −6.6 ± 30.7 , P < 0.005 ) . Although participants in the education group were more likely to report perceived functional benefits from treatment at 3 months follow-up ( RR=1.63 , 95%CI : 1.01–2.63 ) , no significant differences were found in functional disability and kinesiophobia between groups at any time . Conclusions : This study ’s findings support the provision of pain neurophysiology education as a clinical ly effective addition to aquatic exercise Chronic whiplash is a debilitating condition characterized by increased sensitivity to painful stimuli , maladaptive illness beliefs , inappropriate attitudes , and movement dysfunctions . Previous work in people with chronic low back pain and chronic fatigue syndrome indicates that pain neurophysiology education is able to improve illness beliefs and attitudes as well as movement performance . This single-case study ( A-B-C design ) with six patients with chronic whiplash associated disorders ( WAD ) was aim ed at examining whether education about the neurophysiology of pain is accompanied by changes in symptoms , daily functioning , pain beliefs , and behavior . Periods A and C represented assessment periods , while period B consisted of the intervention ( pain neurophysiology education ) . Results showed a significant decrease in kinesiophobia ( Tampa Scale for Kinesiophobia ) , the passive coping strategy of resting ( Pain Coping Inventory ) , self-rated disability ( Neck Disability Index ) , and photophobia ( WAD Symptom List ) . At the same time , significantly increased pain pressure thresholds and improved pain-free movement performance ( visual analog scale on Neck Extension Test and Brachial Plexus Provocation Test ) were established . Although the current results need to be verified in a r and omized , controlled trial , they suggest that education about the physiology of pain is able to increase pain thresholds and improve pain behavior and pain-free movement performance in patients with chronic WAD Introduction Low back pain ( LBP ) is the leading cause of disability worldwide . Of those patients who present to primary care with acute LBP , 40 % continue to report symptoms 3 months later and develop chronic LBP . Although it is possible to identify these patients early , effective interventions to improve their outcomes are not available . This double-blind ( participant/ outcome assessor ) r and omised controlled trial will investigate the efficacy of a brief educational approach to prevent chronic LBP in ‘ at-risk ’ individuals . Methods / analysis Participants will be recruited from primary care practice s in the Sydney metropolitan area . To be eligible for inclusion participants will be aged 18–75 years , with acute LBP ( < 4 weeks ’ duration ) preceded by at least a 1 month pain-free period and at-risk of developing chronic LBP . Potential participants with chronic spinal pain and those with suspected serious spinal pathology will be excluded . Eligible participants who agree to take part will be r and omly allocated to receive 2 × 1 h sessions of pain biology education or 2 × 1 h sessions of sham education from a specially trained study physiotherapist . The study requires 101 participants per group to detect a 1-point difference in pain intensity 3 months after pain onset . Secondary outcomes include the incidence of chronic LBP , disability , pain intensity , depression , healthcare utilisation , pain attitudes and beliefs , global recovery and recurrence and are measured at 1 week post-intervention , and at 3 , 6 and 12 months post LBP onset . Ethics/dissemination Ethical approval was obtained from the University of New South Wales Human Ethics Committee in June 2013 ( ref number HC12664 ) . Outcomes will be disseminated through publication in peer- review ed journals and presentations at international conference meetings . Trial registration number https://www.anzctr.org.au/Trial/ Registration /Trial Review Mounting evidence supports the use of face-to-face pain neuroscience education for the treatment of chronic pain patients . This study aim ed at examining whether written education about pain neuroscience improves illness perceptions , catastrophizing , and health status in patients with fibromyalgia . A double-blind , multicenter r and omized controlled clinical trial with 6-month follow-up was conducted . Patients with FM ( n = 114 ) that consented to participate were r and omly allocated to receive either written pain neuroscience education or written relaxation training . Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties ; the relaxation group received a booklet with relaxation education and a telephone call . The revised illness perception question naire , Pain Catastrophizing Scale , and fibromyalgia impact question naire were used as outcome measures . Both patients and assessors were blinded . Repeated- measures analyses with last observation carried forward principle were performed . Cohen 's d effect sizes ( ES ) were calculated for all within-group changes and between-group differences . The results reveal that written pain neuroscience education does not change the impact of FM on daily life , catastrophizing , or perceived symptoms of patients with FM . Compared with written relaxation training , written pain neuroscience education  improved beliefs in a chronic timeline of FM ( P = 0.03 ; ES = 0.50 ) , but it does not impact upon other domains of illness perceptions . Compared with written relaxation training , written pain neuroscience education slightly improved illness perceptions of patients with FM , but it did not impart clinical ly meaningful effects on pain , catastrophizing , or the impact of FM on daily life . Face-to-face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM The aim of this single-blind pilot RCT was to investigate the effect of pain biology education and group exercise classes compared to pain biology education alone for individuals with chronic low back pain ( CLBP ) . Participants with CLBP were r and omised to a  pain biology education and group exercise classes group ( EDEX ) [ n = 20 ] or a  pain biology education only group  ( ED ) [ n = 18 ] . The primary outcome was pain ( 0 - 100 numerical rating scale ) , and self-reported function assessed using the Rol and Morris Disability Question naire , measured at pre-intervention , post-intervention and three month follow up . Secondary outcome measures were pain self-efficacy , pain related fear , physical performance testing and free-living activity monitoring . Using a linear mixed model analysis , there was a statistically significant interaction effect between time and intervention for both pain ( F[2,49 ] = 3.975 , p < 0.05 ) and pain self-efficacy ( F[2,51 ] = 4.011 , p < 0.05 ) with more favourable results for the ED group . The effects levelled off at the three month follow up point . In the short term , pain biology education alone was more effective for pain and pain self-efficacy than a combination of pain biology education and group exercise classes . This pilot study highlights the need to investigate the combined effects of different interventions Study Design . Multicenter , r and omized , controlled trial on preoperative pain neuroscience education ( NE ) for lumbar radiculopathy . Objective . To determine if the addition of NE to usual preoperative education would result in superior outcomes with regard to pain , function , surgical experience , and health care utilization postsurgery . Summary of Background Data . One in 4 patients after lumbar surgery ( LS ) for radiculopathy experience persistent pain and disability , which is nonresponsive to perioperative treatments . NE focusing on the neurophysiology of pain has been shown to decrease pain and disability in population s with chronic low back pain . Methods . Eligible patients scheduled for LS for radiculopathy were r and omized to receive either preoperative usual care ( UC ) or a combination of UC plus 1 session of NE delivered by a physical therapist ( verbal one-on-one format ) and a NE booklet .  Sixty-seven patients completed the following outcomes prior to LS ( baseline ) , and 1 , 3 , 6 , and 12 months after LS : low back pain ( numeric rating scale ) , leg pain ( numeric rating scale ) , function ( Oswestry Disability Index ) , various beliefs and experiences related to LS ( 10-item survey with Likert scale responses ) , and postoperative utilization of health care ( utilization of health care question naire ) . Results . At 1-year follow-up , there were no statistical differences between the experimental and control groups with regard to primary outcome measure of low back pain ( P = 0.183 ) , leg pain ( P = 0.075 ) , and function ( P = 0.365 ) . In a majority of the categories regarding surgical experience , the NE group scored significantly better : better prepared for LS ( P = 0.001 ) ; preoperative session preparing them for LS ( P < 0.001 ) and LS meeting their expectations ( P = 0.021 ) . Health care utilization post-LS also favored the NE group ( P = 0.007 ) result ing in 45 % less health care expenditure compared with the control group in the 1-year follow-up period . Conclusion . NE result ed in significant behavior change . Despite a similar pain and functional trajectory during the 1-year trial , patients with LS who received NE viewed their surgical experience more favorably and used less health care facility in the form of medical tests and treatments . Level of Evidence : Objectives : Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions , disability , and physical performance . However , it is not known whether the neurophysiology education component of such programs contributes to these outcomes . In chronic low back pain patients , we investigated the effect of neurophysiology education on cognitions , disability , and physical performance . Methods : This study was a blinded r and omized controlled trial . Individual education sessions on neurophysiology of pain ( experimental group ) and back anatomy and physiology ( control group ) were conducted by trained physical therapist educators . Cognitions were evaluated using the  Survey of Pain Attitudes ( revised ) ( SOPA(R ) ) , and the  Pain Catastrophizing Scale ( PCS ) . Behavioral measures included the Rol and Morris Disability Question naire ( RMDQ ) , and 3 physical performance tasks ; ( 1 ) straight leg raise ( SLR ) , ( 2 ) forward bending range , and ( 3 ) an abdominal “ drawing-in ” task , which provides a measure of voluntary activation of the deep abdominal muscles . Method ological checks evaluated non-specific effects of intervention . Results : There was a significant treatment effect on the SOPA(R ) , PCS , SLR , and forward bending . There was a statistically significant effect on RMDQ ; however , the size of this effect was small and probably not clinical ly meaningful . Discussion : Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability . The results suggest that pain neurophysiology education , but not back school type education , should be included in a wider pain management approach Manual therapy , exercise and education target distinct aspects of chronic low back pain and probably have distinct effects . This study aim ed to determine the efficacy of a combined physiotherapy treatment that comprised all of these strategies . By concealed r and omisation , 57 chronic low back pain patients were allocated to either the four-week physiotherapy program or management as directed by their general practitioners . The dependent variables of interest were pain and disability . Assessors were blind to treatment group . Outcome data from 49 subjects ( 86 % ) showed a significant treatment effect . The physiotherapy program reduced pain and disability by a mean of 1.5/10 points on a numerical rating scale ( 95 % CI 0.7 to 2.3 ) and 3.9 points on the 18-point Rol and Morris Disability Question naire ( 95 % CI 2 to 5.8 ) , respectively . The number needed to treat in order to gain a clinical ly meaningful change was 3 ( 95 % CI 3 to 8) for pain , and 2 ( 95 % CI 2 to 5 ) for disability . A treatment effect was maintained at one-year follow-up . The findings support the efficacy of combined physiotherapy treatment in producing symptomatic and functional change in moderately disabled chronic low back pain patients OBJECTIVE To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome ( CFS ) and chronic widespread pain . DESIGN Double-blind r and omized controlled trial . SETTING Specialized chronic fatigue clinic in university hospital . PARTICIPANTS A r and om sample of patients ( N=48 ) with CFS patients ( 8 men , 40 women ) experiencing chronic pain , r and omly allocated to the control group ( n=24 ) or experimental group ( n=24 ) . Two women in the experimental group did not complete the study 
    Output:
    
It increases knowledge of pain-related biology , decreases catastrophizing , and imparts short-term reductions in pain and disability .