The current study is a double-blind, parallel-group randomized controlled trial involving 80 participants with chronic low back pain. The trial will compare a program of Pain Neuroscience Education plus Sensory Discrimination Training and core stability exercises with a program of Pain Neuroscience Education and core stability exercises alone. Interventions will be delivered twice weekly for eight weeks. The primary outcome is pain catastrophizing. Secondary outcomes include kinesiophobia and functional movements. Assessments will be conducted at baseline, 4, and 8 weeks. The trial will be carried out at Nutricao Lahore Clinic and Model Town Hospital, Lahore. The hypothesis is that Pain Neuroscience Education with Sensory Discrimination Training will result in greater reductions in pain catastrophizing and kinesiophobia, as well as improvements in functional movements.
Age: 19 to 44 Both Genders Mechanical low back pain (duration more than 6 months and less than 2 years) >4/10 Numerical Pain Rating Scale (NPRS)
Pregnancy or post-partum Trauma Psychological Pain Radicular Pain Cancer, tumor, malignancy Neurological Deficit Recent Surgery <1year
Parallel
Pain Neuroscience Education with Sensory Discrimination Training and Core Stability Exercises
Other interventionAlthough both Pain Neuroscience Education and Sensory Discrimination Training have demonstrated potential benefits individually, there is a paucity of research evaluating their combined effects. Integrating cognitive (PNE) and sensorimotor (SDT) approaches may produce synergistic effects, improving pain modulation, functional capacity, and psychological resilience.
Pain Neuroscience Education and Core stability Exercises
Other interventionParticipants in the control group will receive the same 45-minute sessions twice per week, but will not receive sensory discrimination training.
Pain Catastrophizing
Pain catastrophizing refers to a maladaptive cognitive and emotional response to actual or perceived pain. Pain Catastrophizing is measured by the Pain Catastrophizing Scale. The Pain Catastrophizing Scale is a validated questionnaire used to measure the degree of catastrophic thinking in individuals experiencing pain (Sullivan et al. 1995). The scale consists of 13 items, each representing a different catastrophizing response. For each item, participants rate their experience using a 5-point Likert scale, where 0 = Not at all (the thought or feeling never occurred) and 4 = All the time (the thought or feeling occurred persistently). The total score ranges from 0 to 52, with higher scores indicating greater levels of pain catastrophizing.
Kinesiophobia
Kinesiophobia is a debilitating fear of movement and physical activity due to the belief that movement will cause pain or re-injury. Kinesiophobia is measured by the Tampa Scale for Kinesiophobia. Tampa Scale for Kinesiophobia is the most widely used and validated tool to assess the fear of movement or re-injury. It contains 17 items. Each item is scored using a 4-point Likert scale with 1 = strongly disagree and 4 = strongly agree. Total score ranges from 17 to 68, with higher scores indicating greater kinesiophobia.
Functional Movements
Functional movement refers to the basic movements that people need in daily life to perform normal activities safely and efficiently. These movements involve multiple joints and muscle groups working together in a coordinated way. Functional movements will be assessed using 2D motion analysis through the Kinovea software. Participants will perform two standardized tasks: forward bending and sit-to-stand. All movements will be recorded using a fixed camera positioned at a consistent height (e.g., 1.2 m) and distance (e.g., 2.5 m) from the participant. Kinovea will be used to extract trunk flexion angle, lumbar deviation from the midline, pelvic tilt angle and task completion time. Higher movement quality, reduced deviation, and faster task completion will be interpreted as improved functional performance.
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