A Randomized Trial to Evaluate the Efficacy of a Pain Neuroscience Education Program on Executive Function and Pain Intensity in Women with Fibromyalgia

Arch Phys Med Rehabil. 2026 Feb 16:S0003-9993(26)00083-3. doi: 10.1016/j.apmr.2026.02.006. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy of a brief, structured Pain Neuroscience Education (PNE) program on executive function and pain intensity in women with Fibromyalgia (FM).

DESIGN: Randomized clinical trial.

SETTING: Rheumatology and pain clinics in Mexico and Colombia.

PARTICIPANTS: Sixty-two women aged 40-60 years diagnosed with FM according to ACR 2010 criteria.

INTERVENTIONS: Participants were randomized to either PNE plus usual care or usual care alone. The intervention consisted of ten 40-45 min online PNE sessions delivered over five weeks.

MAIN OUTCOME MEASURES: Co-primary outcomes were pain intensity, assessed with the Visual Analog Scale (VAS); FM impact, assessed with the Fibromyalgia Impact Questionnaire Revised (FIQ-R); and executive function (multidimensional domain), assessed with four tasks: the Wisconsin Card Sorting Test (WCST; cognitive flexibility), the Simon Task (ST; inhibition), the Corsi Block-Tapping Task (CT; visuospatial working-memory capacity), and the Digit Span Forward Task (DST; phonological working-memory capacity). Secondary outcomes were central sensitization (Central Sensitization Inventory, CSI), pain catastrophizing (Pain Catastrophizing Scale, PCS), kinesiophobia (Tampa Scale for Kinesiophobia-11, TSK-11), depressive symptoms (Beck Depression Inventory-II, BDI-II), and anxiety (State-Trait Anxiety Inventory, STAI).

RESULTS: Compared with controls, the PNE group showed greater reductions in pain (-3.24; p=.001), FM impact (-15.14; p=.001), central sensitization (-22.36; p=.001), catastrophizing (-7.24; p=.020), and kinesiophobia (-8.68; p=.001). Depressive symptoms also improved (-6.78; p=.023). Trait anxiety decreased more in the control group (p=.001). Executive function effects were domain-specific: phonological working memory (Digit Span Forward) improved significantly (p=.007), whereas no significant effects were observed for visuospatial working memory, cognitive flexibility, or inhibition after multiplicity adjustment.

CONCLUSION: PNE plus usual care significantly improves pain, functional impact, central sensitization, catastrophizing, kinesiophobia, and phonological working memory in FM. Cognitive effects were selective (no improvement in flexibility, inhibition, or visuospatial working memory) and mood outcomes were mixed.

TRIAL REGISTRATION: ClinicalTrials.gov (identifier masked for double-anonymous peer review).

PMID:41707793 | DOI:10.1016/j.apmr.2026.02.006