Trial reportPloS one2026
The effect of integrating pain neuroscience education with stabilization exercises using a flexi-bar on functional disability, pain, and geometry of abdominal and multifidus muscles in patients with chronic non-specific low back pain.
Trial report in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
5 authors.
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Abstract
objectiveChronic non-specific low back pain is a multifactorial condition encompassing both physical and psychosocial components, frequently characterized by maladaptive pain-related cognitions and fear-avoidance behaviours. Pain neuroscience education seeks to reconceptualize these cognitions and mitigate pain-related fear. This study evaluated the additional benefits of integrating pain neuroscience education with Flexi-Bar-based stabilization exercises on pain intensity, functional disability, and geometry of the abdominal and lumbar Multifidus muscles in individuals with chronic non-specific low back pain.
methodsForty-eight participants diagnosed with chronic non-specific low back pain were randomly allocated to one of two groups: (1) Pain neuroscience education followed by Flexi-Bar stabilization exercises or (2) Flexi-Bar stabilization exercises alone. Both groups underwent supervised Flexi-Bar stabilization training sessions three times a week for six weeks. The primary outcome was functional disability assessed by the Roland-Morris Questionnaire at baseline, immediately post-intervention, and at the 4-week follow-up. Secondary outcomes included pain intensity, kinesiophobia, pain catastrophizing, and fear-avoidance beliefs, all measured at the same three time points, as well as ultrasound-based geometry of abdominal and lumbar multifidus muscles, which was assessed at baseline and post-intervention in supine, seated, and standing positions.
resultRepeated-measures ANOVA revealed significant Time × Group interaction effects, main effects of time, and main effects of Group for both functional disability and pain intensity (p < 0.05). Ultrasound analysis demonstrated significant post-intervention increases in Transverse Abdominis and lumbar Multifidus muscle thickness across all tested positions (p < 0.05), with the pain neuroscience education plus exercise group exhibiting significantly greater increases compared to the exercise-only group.
conclusionThe combined PNE plus stabilization exercises yielded superior improvements in pain, disability, and muscle geometry compared with stabilization alone. However, the absence of a PNE-only group precludes isolating the educational component's unique contribution. Iranian Registry of Clinical Trials; prospectively registered (Trial number: IRCT20230505058095N1).
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