Effects of pain neuroscience education plus resistance training on pain, disability, and sensitization in women with fibromyalgia syndrome: A randomized controlled trial

BACKGROUND AND OBJECTIVE: Fibromyalgia syndrome (FMS) is characterized by widespread pain, disability, and central sensitization (CS)-related symptoms. Although exercise is strongly recommended, uncertainty remains about the most effective modality and the added value of pain neuroscience education (PNE). This study aimed to compare the effects of PNE combined with resistance training (PNE+RT) versus aerobic and flexibility exercise (AE+FE) on pain, disability, and CS-related symptoms in women with FMS. METHODS: This randomized controlled trial was conducted in a university clinical setting. Sixty women with FMS (mean age 50 years) were randomized using a concealed, computer-generated sequence to PNE+RT (n = 30) or AE+FE (n = 30). Both groups completed a 12-week program (three sessions/week); the experimental group received six PNE sessions. Primary outcomes were pain intensity, disability, and CS-related symptoms assessed at baseline, post-intervention, and 1, 3, and 6 months. Secondary outcomes included maximum handgrip strength (MHS), pressure pain threshold (PPT), and stiffness. Between-group and time effects were analyzed using mixed ANOVA. RESULTS: PNE+RT yielded significant, clinically meaningful reductions in pain (p < 0.001, ηₚ²=0.227), and improvements in PPT (p < 0.001; large effects in trapezius ηₚ²=0.222-0.217, quadriceps ηₚ²=0.122-0.098) and MHS (p < 0.01, ηₚ²=0.152), with time×group interactions favoring PNE+RT. Both groups improved in disability (p < 0.01, ηₚ²=0.235) and CS-related symptoms (p < 0.001, ηₚ²=0.255) without between-group differences. No changes occurred in stiffness. No adverse events were reported. CONCLUSIONS: PNE+RT is as effective as AE+FE in women with FMS for improving pain intensity, disability, and CS-related symptoms. However, PNE+RT appears to provide additional clinical benefits in pain sensitivity and muscle strength. These results support clinical guidelines and emphasize considering patient preferences when selecting programs.