Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study. — CFSMEATLAS
Kinesiophobia and maladaptive coping strategies prevent improvements in pain catastrophizing following pain neuroscience education in fibromyalgia/chronic fatigue syndrome: An explorative study.
Malfliet, Anneleen, Van Oosterwijck, Jessica, Meeus, Mira et al. · Physiotherapy theory and practice · 2017 · DOI
Quick Summary
This study looked at why some people with ME/CFS and fibromyalgia benefit more from a type of pain education (called pain neuroscience education) than others. The researchers found that patients who were very afraid of movement or who tended to worry a lot about their pain showed less improvement in their catastrophic thinking about pain after receiving this education. This suggests that for some patients, education alone may not be enough—they might need additional support to address their fears and worries.
Why It Matters
Understanding which patients respond poorly to pain neuroscience education helps clinicians tailor treatments more effectively and identify who needs additional interventions. For ME/CFS patients, this research highlights that addressing fear of movement and unhelpful coping strategies alongside education may be necessary to achieve meaningful improvements in pain-related suffering.
Observed Findings
High baseline kinesiophobia (fear of movement) was associated with smaller reductions in overall pain catastrophizing after PNE.
Patients with high baseline kinesiophobia showed less improvement in rumination (repetitive negative thinking about pain).
Patients who reported high levels of worry-based coping at baseline experienced significantly less improvement in catastrophic thinking.
Patients who used retreating/avoidance coping strategies showed less benefit from PNE.
Pain neuroscience education alone produced variable outcomes depending on these psychological baseline factors.
Inferred Conclusions
Kinesiophobia and maladaptive coping strategies (worrying and retreating) are barriers to PNE effectiveness in CFS/FM patients.
PNE as a standalone intervention is insufficient for reducing pain catastrophizing in patients with these psychological characteristics.
Clinicians should screen for kinesiophobia and unhelpful coping patterns and may need to integrate additional psychological interventions (such as cognitive-behavioral approaches or exposure therapy) alongside PNE.
Remaining Questions
What specific supplementary treatments are most effective for patients with high kinesiophobia or worry-based coping when combined with PNE?
What This Study Does Not Prove
This study does not prove that kinesiophobia and worry directly cause poor PNE response—only that they are associated with it. The small sample size (n=39) and observational design limit generalizability. The study does not establish what supplementary treatments would be most effective for these patient subgroups.