Background: Clinical reasoning is a critical skill for physical therapists, involving the collection and interpretation of patient information to form accurate diagnoses. Traditional training often lacks the diversity of clinical cases necessary for students to develop these skills comprehensively. Large language models (LLMs) like GPT-4 have the potential to simulate a wide range of clinical scenarios, offering a novel approach to enhance clinical reasoning in physical therapy education. Objective: The aim of the study is to explore the main barriers and facilitators that could be encountered in conducting a randomized clinical trial to study the effectiveness of the implementation of LLM models as tools to work on the clinical reasoning of physical therapy students. Methods: This pilot randomized parallel-group study involved 46 third-year physical therapy students at La Salle Centre for Higher University Studies. Participants were randomly assigned to either the experimental group, which received LLM training, or the control group, which followed the usual curriculum. The intervention lasted for 4 weeks, during which the experimental group used LLM to solve weekly clinical cases. Digital competencies, satisfaction, and costs were evaluated to explore the feasibility of this intervention. Results: The recruitment and participation rates were high, but active engagement with the LLM was low, with only 5.75% (5/23) of the experimental group actively using the model. No significant difference in overall satisfaction was found between the groups, and the cost analysis reflected an initial cost of US $1738 for completing the study. Conclusions: While LLMs have the potential to enhance specific digital competencies in physical therapy students, their practical integration into the curriculum faces challenges. Future studies should focus on improving student engagement with LLMs and extending the training period to determine the feasibility of integrating this tool into physical therapy education and maximize benefits.

Background and Objectives: Exercise-induced hypoalgesia (EIH) is a topic of interest in the scientific community. This umbrella review aimed to analyze EIH research and compare it with public dissemination on X. Materials and Methods: We selected relevant EIH reviews that included a healthy population or patients with pain and studied exercise interventions. A systematic literature search was carried out in PubMed, Web of Science, SciELO, PEDro, and Google Scholar, employing the Population, Intervention, Comparison, and Outcome strategy. Data were extracted and summarized, and methodological quality was assessed with the Quality Assessment Scale for Systematic Reviews, and risk of bias with the Risk of Bias in Systematic Reviews tool. The Physical Activity Guidelines Advisor Committee was employed for evidence synthesis. Simultaneously, advanced X website searches gathered EIH-related content for analysis. Information from posts on X was qualitatively analyzed and contrasted with evidence in the literature. Results: We included nine systematic reviews and 17 narrative reviews. Systematic reviews presented high methodological quality. However, half had low risk of bias, while the other half presented high risk of bias. The EIH in healthy participants was controversial for some exercise modalities, such as aerobic exercise, and the influence of psychological variables. Modalities, such as isotonic resistance exercise, showed favorable effects on hypoalgesia. However, in patients with musculoskeletal pain, different exercise modalities did not generate EIH. X analysis unveiled a considerable representation of science-related content, although with prevalent misinterpretations of scientific evidence. Conclusions: EIH has been extensively studied, yet the certainty of evidence remains limited. While some exercise modalities demonstrate hypoalgesic effects in asymptomatic individuals, these effects remain unverified in patients with musculoskeletal pain. Moreover, the analysis of social media content highlights frequent misinterpretations of scientific evidence, particularly conflating hypoalgesia with analgesia. This underscores the need for more precise, evidence-based communication on social media platforms.

Background: Chronic pain conditions are complex multifactorial disorders with physical, psychological, and environmental factors contributing to their onset and persistence. Among these conditions, the role of brain-derived neurotrophic factor (BDNF) and the impact of a specific therapeutic education (TE) on pain management have emerged as important areas of research. Objective: This study aims to investigate the effects of a specific type of therapeutic education on pain levels and BDNF concentrations. Methods: In this single-blind, randomized clinical trial, patients will be randomly assigned to one of two groups: one will receive exercise with TE and the other without TE. Assessments will be made at baseline, mid-treatment, post-intervention, and at one and eight months. Outcomes: This study will shed light on the effectiveness of a therapeutic education (TE) program in pain management. Additionally, it will provide information on its effects on BDNF levels, a biomarker of brain plasticity, as well as on various psychosocial variables that can influence pain experience. Conclusion: By comprehensively addressing the need to quantify brain changes more precisely in individuals with chronic pain during interventions like TE and recognizing the importance of establishing a more structured and comprehensive protocol, this study lays a solid and replicable foundation for future evidence-based treatment developments.

Background/Objectives: Fibromyalgia syndrome (FMS) is a multifactorial pain syndrome not only characterized by widespread pain as the primary symptom but also accompanied by physical, psychological, and cognitive manifestations. Impairments in conditioned pain modulation (CPM) are common in this population; however, there is significant heterogeneity in the CPM response among women with FMS. The Left/Right Judgment Task (LRJT) is a validated method for studying motor imagery in chronic pain patients. Previous scientific evidence has not yet thoroughly investigated the relationship between CPM alterations and motor imagery processes in FMS patients. The aim of this study was to investigate the relationship between CPM and motor imagery. Methods: This is a secondary analysis of a cross-sectional study. Pain intensity (NPRS), disability (FIQ), mechanical hyperalgesia (PPT), descending pain modulation (CPM), and laterality discrimination (LRJT) were assessed in 30 women diagnosed with FMS. Participants were divided into two groups, responder and non-responder, according to their response to the CPM test. Results: Findings showed that the FMS subgroup of non-responders to CPM, performed worse in motor imagery processes (LRJT). Additionally, older age and higher mechanical hyperalgesia were also associated with poorer functioning of the inhibitory system. Conclusions: Women with FMS who are non-responders to CPM exhibit a reduced ability to perform motor imagery processes. Additionally, the non-responder group shown significant differences, such as older age and greater initial mechanical hyperalgesia compared to the responder group.

Objective: The main objectives of this review were, firstly, to study the effect of different physiotherapy interventions on BDNF levels, and, secondly, to analyze the influence of physiotherapy on pain levels to subsequently draw conclusions about its possible relationship with BDNF. Background: Based on the theory that neurotrophic factors such as BDNF play a fundamental role in the initiation and/or maintenance of hyperexcitability of central neurons in pain, it was hypothesized that the levels of this neurotrophic factor may be modified by the application of therapeutic interventions, favoring a reduction in pain intensity. Methods: A literature search of multiple electronic databases (Pubmed, PsycINFO, Medline (Ebsco), Scopus, WOS, Embase) was conducted to identify randomized control trials (RCTs) published without language restrictions up to and including March 2022. The search strategy was based on the combination of medical terms (Mesh) and keywords relating to the following concepts: “pain”, “chronic pain”, “brain derived neurotrophic factor”, “BDNF”, “physiotherapy”, and “physical therapy”. A total of seven papers were included. Results: There were two studies that showed statistically significant differences in pain intensity reduction and an increase in the BDNF levels that used therapies such as rTMS and EIMS in patients with chronic myofascial pain. However, the same conclusions cannot be drawn for the other physical therapies applied. Conclusions: rTMS and EIMS interventions achieved greater short-term reductions in pain intensity and increased BDNF over other types of interventions in chronic myofascial pain patients, as demonstrated by a moderate amount of evidence. In contrast, other types of physical therapy (PT) interventions did not appear to be more effective in decreasing pain intensity and increasing BDNF levels than placebo PT or minimal intervention, as a low amount of evidence was found.

Introduction: PNE, focusing on cognitive aspects, aims to change patients’ beliefs about pain. However, it is unclear if these cognitive changes are sufficient to influence other components such as neuroplastic changes. Objective: To assess whether 3-h pain neuroscience education (PNE) can induce changes in brain-derived neurotrophic factor (BDNF) levels and pain intensity in chronic pain patients. Methods: A double-blind randomized clinical trial was conducted with 66 participants aged 18–65 years old (50.86 ± 8.61) with chronic primary musculoskeletal pain divided into two groups: an intervention group receiving 3-h PNE lecture and a control group that received an educational booklet. Primary outcomes included plasma BDNF levels and perceived pain intensity (VAS). Secondary outcomes included anxiety (HADS-A), depression (HADS-D), catastrophizing (PCS), kinesiophobia (TSK), stress (PSS), and knowledge about pain. Measurements were taken in both groups before and after a three-hour intervention. Data were analyzed using paired t-tests and Cohen’s d for effect sizes. Results: The results showed no significant changes in BDNF levels for the PNE lecture group (p = 0.708) or the educational booklet group (p = 0.298). Both groups showed significant reductions in pain intensity (PNE: p < 0.001, d = 0.70; booklet: p = 0.036, d = 0.39). Secondary variables, such as knowledge (PNE: p < 0.001, d = −0.972; booklet: p < 0.001, d = −0.975) and anxiety (PNE: p < 0.001, d = 0.70; booklet: p = 0.035, d = 0.39), also showed significant improvements. Conclusions: PNE did not significantly change BDNF levels but effectively improved pain intensity, pain-related knowledge, and other clinical variables. These findings suggest that while PNE has cognitive benefits, it may not be sufficient to induce immediate neurobiological changes. Further research is needed to explore long-term effects and incorporate additional therapeutic domains.