Effects of a Pain Oriented Biobehavioral Therapeutic Education Program on Brain Plasticity and Pain Intensity in Subjects with Chronic Musculoskeletal Pain: A Feasibility Study of a Randomized Controlled Trial

Silvia Di-Bonaventura¹Aser Donado Bermejo²Luis Matesanz-García³Miguel Molina-Álvarez²Jose Vicente León Hernández³Angel Lizcano-Alvarez¹Sergio Lerma³Maximiliano Nogales-Morales³Nuria Molina⁴Josue Fernandez-Carnero^1,2Francisco Gurdiel-Álvarez^2,3,5*Raúl Ferrer-Peña^2,3,5

• ¹Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
• ²Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, MAdrid, Spain
• ³Department of Physiotherapy, Faculty of Health, La Salle University Center, Madrid, Spain
• ⁴Independent Researcher, Madrid, Spain
• ⁵Grupo de Investigación Clínico-Docente sobre Ciencias de la Rehabilitación (INDOCLIN), CSEU La Salle, UAM, Aravaca, Madrid, Spain

Background: Chronic pain significantly impacts the physical, emotional, and social well-being of individuals. Despite advances in treatments, chronic pain prevalence continues to rise, emphasizing the need for comprehensive therapeutic approaches. Objective: This study aimed to evaluate the feasibility and preliminary effects of a one-month Pain Oriented Biobehavioral Therapeutic Education (POBTE) program on clinical outcomes for chronic primary musculoskeletal pain. Methods: In a single-blind feasibility pilot of a randomized controlled trial, 16 participants were assigned to an intervention group receiving POBTE education and exercise (n=8) or a control group (n=8) participating in exercise only. Primary outcomes were pain intensity, measured by the Numeric Pain Rating Scale, and Brain-Derived Neurotrophic Factor (BDNF) plasma levels. Results: The intervention group showed a significant increase in BDNF levels from a mean of 2.174 at baseline to 3.063 at the end of treatment (p = 0.001, r = 0.63), with a non-significant reduction in pain intensity. Secondary outcomes, including anxiety, sleep quality, and physical activity, improved significantly. The results, however, should be interpreted cautiously due to the small sample size. Conclusion: The POBTE program appears feasible and acceptable, showing preliminary signals consistent with potential improvements in several clinical variables related to chronic pain management. These exploratory findings support the need for larger-scale, adequately powered trials.