Effectiveness of a Pain Neuroscience Education and Therapeutic Exercise Program Delivered by Primary Care Physiotherapists to Patients With Chronic Nociplastic Spinal Pain

"The sessions will be conducted in groups of 10 to 15 patients.~* 4 pain science education sessions, each lasting 1.5 hours (6 hours), with one session per week, for 4 weeks.~* 12 therapeutic physical exercise program sessions, each lasting 1 hour, to be conducted over 6 weeks (12 hours), with two sessions per week. Although the intervention is group-based, individual instructions will be given to patients. Reference will be made to the content learned in the neuroeducation sessions. The exercise dose must be adjusted to the patient's condition, keeping in mind that, due to the inhibition of the descending pain modulation system, they may experience an initial increase in pain during the first sessions, so as not to alarm the patient and prevent the activity from being discontinued. The main objective is to increase the patient's functionality, an aspect that will be constantly reinforced.~The session structure will be as recommended by the American College of Sports Medicine, with se"

"Patients assigned to this group will receive, in addition to the same intervention as the AADC study group intervention type 2 (education about pain), somatosensory and body schema treatment for the changes observed in an initial assessment during the 4 weeks prior.~The prescribed treatment will be repeated daily at home. To facilitate~the progress of the treatment, it is recommended that a companion participate in the first session, when possible, where the daily intervention to be performed at home will be explained.~If the participation of a companion is not possible, the patient will attend the Health Center's physiotherapy room once a day to be accompanied by the physiotherapist and offered the same treatment opportunities.~As a control and monitoring measure, the patient will attend the physiotherapy room once a week and will be called again weekly to verify that the treatment is being performed correctly. They will also be provided with a form to record their home treatment."

The patients will receive the usual physiotherapy treatment provided in Primary Care Physiotherapy units, supported by the current Primary Care Physiotherapy protocols of Castilla y León, since Andalusia does not currently have any published. The patient will receive 12 sessions of thermotherapy (Infrared/Microwave) and analgesic electrotherapy (analgesic Tens currents) in the painful area(s), and will be prescribed exercises recommended by the Spanish Society of Physical Medicine and Rehabilitation (SERMEF). The learning and execution of the exercises will be supervised by a Primary Care physiotherapist. The sessions will be with a frequency of 2 per week on alternate days for 6 weeks.