Multimodal Lifestyle Approach for Chronic Pain With Nociplastic Pain Features (MLA-MM)

Intervention Using a Multimodal Lifestyle Approach for Patients With Chronic Pain Showing Nociplastic Pain Features: A Single-Arm Pilot Feasibility Study

This single-center, single-arm pilot feasibility study aims to examine the feasibility and preliminary effectiveness of an intervention program using a pain education booklet based on a multimodal lifestyle approach for patients with chronic pain with features of nociplastic pain. Participants will receive pain education and self-management support using a booklet developed by the investigators, together with exercise therapy provided as part of usual outpatient rehabilitation. The intervention includes pain science education, shared decision-making, goal setting, physical activity and exercise, sleep, stress management, diet, work environment, headache-related lifestyle factors, and strategies for recovery-oriented and sustainable activities. Feasibility outcomes include recruitment and consent rates, intervention completion rate, assessment completion rate, participant satisfaction, reasons for dropout, adverse events, and practical difficulties during implementation. Preliminary effectiveness will be explored using patient-reported outcomes and physical function measures at baseline, 6 weeks, and 12 weeks.

Study Overview

• Status: Not yet recruiting
• Conditions: Chronic Pain; Nociplastic Pain
• Intervention / Treatment: Behavioral: Multimodal Lifestyle Approach Using a Pain Education Booklet

Detailed Description

Chronic pain has a substantial impact on activities of daily living, quality of life, work participation, and socioeconomic burden. Chronic pain is understood within a biopsychosocial framework, and modifiable lifestyle factors such as sleep, stress, physical activity, and exercise may contribute to the persistence or exacerbation of pain. In recent years, nociplastic pain has been recognized as an important mechanism in some patients with chronic pain that cannot be fully explained by nociceptive or neuropathic pain alone. Nociplastic pain may be associated with widespread pain, hyperalgesia, sleep disturbance, fatigue, mood and cognitive symptoms, and sensory hypersensitivity. A multimodal lifestyle approach, which combines pain education with individualized support for lifestyle factors such as physical activity, exercise, sleep, and stress management, may be useful for patients with chronic pain showing nociplastic pain features. Therefore, this study will evaluate the feasibility and preliminary effectiveness of a booklet-based multimodal lifestyle intervention in an outpatient clinical setting. This initial feasibility study will focus on a general outpatient chronic pain population with suspected nociplastic pain features, while excluding specific or complex pain-related conditions that may require specialized management. As this is a single-arm pilot feasibility study delivered within usual outpatient rehabilitation, preliminary effectiveness outcomes will be interpreted exploratorily and will not be used to estimate causal effects. The findings will inform the feasibility, acceptability, and design of a future controlled trial.

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tomohiko Nishigami, PhD; Phone Number: +81 848-60-1120; Email: tomon@pu-hiroshima.ac.jp

Study Locations

• Japan
  • Hiroshima
    • Mihara, Hiroshima, Japan, 725-0053
      • Prefectural University of Hiroshima
      • Contact: Tomohiko Nishigami, Professor; Phone Number: +81 848-60-1120; Email: tomon@pu-hiroshima.ac.jp
  • Osaka
    • Ibaraki, Osaka, Japan, 567-0829
      • SKY Clinic
      • Contact: Hirofumi Yamashita, MSc; Phone Number: +81 72 638 7676; Email: yamashita.hf@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Receiving rehabilitation services at the study site.
2. Aged 20 to 75 years.
3. Chronic pain lasting for at least 3 months.
4. Pain intensity of 3 or higher on an 11-point Numerical Rating Scale.
5. Suspected involvement of nociplastic pain, assessed using a screening procedure based on clinical criteria and grading for chronic nociplastic pain affecting the musculoskeletal system.
6. Able and willing to provide written informed consent.

Screening Procedure for Nociplastic Pain Features The involvement of nociplastic pain features will be assessed before enrollment using a structured screening form developed by the research group based on the clinical criteria and grading system for chronic nociplastic pain affecting the musculoskeletal system proposed by Kosek et al. The screening form is not intended to establish a definitive diagnosis of nociplastic pain, but to identify patients with suspected nociplastic pain features for eligibility.

The screening procedure includes assessment of pain duration, pain distribution, possible nociceptive and neuropathic pain mechanisms, hyperalgesia or allodynia, history of hypersensitivity, and comorbid symptoms related to central sensitization. The screening algorithm and assessment items will be documented in the study materials to improve transparency and reproducibility.

Exclusion Criteria:

1. Presence of specific pain-related conditions or symptoms, including fracture, rheumatic disease, musculoskeletal surgery within the past 3 years, fibromyalgia, or complex regional pain syndrome.
2. Inability to follow the study schedule.
3. Receiving compensation for absence from work due to a traffic accident or work-related injury.
4. Difficulty using Japanese.
5. Cognitive impairment that may affect the assessment procedures or pain education.
6. Possibility of pregnancy during the study period.
7. Previous experience of Pain Neuroscience Education.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Multimodal Lifestyle Approach; Participants in this single-arm study will receive a 12-week booklet-based multimodal lifestyle intervention, together with exercise therapy as part of usual outpatient rehabilitation. The intervention focuses on pain education, goal setting, shared decision-making, lifestyle-related self-management, recovery-oriented activities, and exercise or physical activity guidance.

Behavioral: Multimodal Lifestyle Approach Using a Pain Education Booklet; Participants will receive booklet-based pain education and self-management support using a multimodal lifestyle approach, together with exercise therapy as part of usual outpatient rehabilitation. The intervention will be delivered once per week for 12 weeks, with each session lasting approximately 40 minutes. Core components include goal setting, shared decision-making, pain science education, lifestyle support, recovery-oriented activities, and exercise or physical activity guidance. The first session will include orientation to the booklet and confirmation of pain-related problems and goals. Subsequent sessions will review understanding, progress, and barriers, and adjust goals or self-management strategies as needed. The physiotherapist may tailor the emphasis, exercise content, and self-management strategies according to each participant's symptoms, goals, and response to rehabilitation. Intervention fidelity will be monitored using session records and a checklist.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility Outcome: Consent Rate	The proportion of eligible patients who provide written informed consent to participate in the study. The feasibility criterion for consent will be met if at least 50% of eligible patients provide written informed consent.	From the start of recruitment until completion of participant enrollment
Feasibility Outcome: Intervention Completion Rate	The proportion of enrolled participants who complete the 12-week multimodal lifestyle approach intervention program. Dropouts, withdrawals, and reasons for non-completion will also be recorded. The feasibility criterion for intervention completion will be met if at least 70% of enrolled participants complete the intervention program.	Baseline to 12 weeks
Feasibility Outcome: Participant Satisfaction and Acceptability	Participant satisfaction and acceptability of the multimodal lifestyle approach intervention program will be assessed using satisfaction ratings and a semi-structured interview at 12 weeks. The interview will explore useful components of the intervention, the most useful content and reasons, and suggestions for improvement. The feasibility criterion for satisfaction will be met if the median participant satisfaction rating is at least 8 out of 10.	6 weeks and 12 weeks
Feasibility Outcome: Adverse Events	The occurrence, type, and severity of adverse events related to assessment, pain education, self-management support, or exercise therapy during the study period will be recorded. The feasibility criterion for safety will be met if no serious adverse events definitely or probably related to the intervention occur during the study period.	Screening to 12 weeks
Pain Intensity	Pain intensity will be assessed using the pain intensity items of the Brief Pain Inventory. Each item is rated on an 11-point numeric rating scale from 0 to 10, where 0 indicates "no pain" and 10 indicates "pain as bad as you can imagine." The mean score ranges from 0 to 10, with higher scores indicating greater pain intensity. Screening pain intensity will be used to confirm eligibility, and follow-up assessments at 6 and 12 weeks will be used to explore changes over time.	Screening, 6 weeks, and 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Interference	Pain interference will be assessed using the interference items of the Brief Pain Inventory. Each item is rated on an 11-point numeric rating scale from 0 to 10, where 0 indicates "does not interfere" and 10 indicates "completely interferes." Higher scores indicate greater pain interference.	Baseline, 6 weeks, and 12 weeks
Pain-Related Disability	Pain-related disability will be assessed using the Pain Disability Index. The total score ranges from 0 to 70, with higher scores indicating greater pain-related disability.	Baseline, 6 weeks, and 12 weeks
Central Sensitization-Related Symptoms	Central sensitization-related symptoms will be assessed using the Central Sensitization Inventory. The total score ranges from 0 to 100, with higher scores indicating more severe central sensitization-related symptoms.	Screening, 6 weeks, and 12 weeks
Pressure Pain Threshold	Pressure pain threshold will be measured using a pressure algometer. The pressure pain threshold is defined as the minimum pressure intensity at which the participant first perceives the stimulus as painful. Higher values indicate lower mechanical pain sensitivity.	Baseline, 6 weeks, and 12 weeks
Temporal Summation	Temporal summation of pain will be assessed using repeated pinprick stimulation. The temporal summation response will be calculated as the change in pain rating from the initial stimulus to repeated stimuli. Higher values indicate greater temporal summation of pain.	Baseline, 6 weeks, and 12 weeks
Conditioned Pain Modulation	Conditioned pain modulation will be assessed using pressure stimulation as the test stimulus and a conditioning stimulus. The conditioned pain modulation response will be calculated as the change in pressure pain threshold or pain rating during the conditioning stimulus compared with the test stimulus alone. Greater pain inhibition indicates more efficient endogenous pain modulation.	Baseline, 6 weeks, and 12 weeks
Pain Catastrophizing	Pain catastrophizing will be assessed using the short form of the Pain Catastrophizing Scale. The total score ranges from 0 to 24, with higher scores indicating greater pain catastrophizing.	Baseline, 6 weeks, and 12 weeks
Kinesiophobia	Kinesiophobia will be assessed using the Tampa Scale for Kinesiophobia-11. The total score ranges from 11 to 44, with higher scores indicating greater fear of movement.	Baseline, 6 weeks, and 12 weeks
Pain Self-Efficacy	Pain self-efficacy will be assessed using the Pain Self-Efficacy Questionnaire-4. The total score ranges from 0 to 24, with higher scores indicating greater pain self-efficacy.	Baseline, 6 weeks, and 12 weeks
Anxiety Symptoms	Anxiety symptoms will be assessed using the Generalized Anxiety Disorder-2. The total score ranges from 0 to 6, with higher scores indicating more severe anxiety symptoms.	Baseline, 6 weeks, and 12 weeks
Depressive Symptoms	Depressive symptoms will be assessed using the Patient Health Questionnaire-2. The total score ranges from 0 to 6, with higher scores indicating more severe depressive symptoms.	Baseline, 6 weeks, and 12 weeks
Insomnia Symptoms	Insomnia symptoms will be assessed using the Athens Insomnia Scale. The total score ranges from 0 to 24, with higher scores indicating more severe insomnia symptoms.	Baseline, 6 weeks, and 12 weeks
Body Perception	Body perception will be assessed using a region-specific Fremantle Awareness Questionnaire selected according to the participant's primary pain region: the Fremantle Back Awareness Questionnaire, Fremantle Neck Awareness Questionnaire, Fremantle Shoulder Awareness Questionnaire, or Fremantle Knee Awareness Questionnaire. Each questionnaire has a total score ranging from 0 to 36, with higher scores indicating greater disturbance in body perception for the corresponding body region.	Baseline, 6 weeks, and 12 weeks
Physical Activity	Physical activity will be assessed using the Global Physical Activity Questionnaire. Total physical activity will be expressed as metabolic equivalent task (MET)-minutes per week. Higher values indicate greater physical activity.	Baseline, 6 weeks, and 12 weeks
Activity Pacing	Activity pacing will be assessed using the pacing scale of the Patterns of Activity Measure-Pain. The pacing scale score ranges from 0 to 40, with higher scores indicating greater use of activity pacing.	Baseline, 6 weeks, and 12 weeks
Work Productivity	Work productivity will be assessed using the World Health Organization Health and Work Performance Questionnaire. Work performance will be rated on a scale from 0 to 10, with higher scores indicating better work performance.	Baseline, 6 weeks, and 12 weeks
Health-Related Quality of Life	Health-related quality of life will be assessed using the EuroQol 5-Dimension 5-Level Questionnaire. The index score will be calculated using the Japanese value set. Scores range from -0.025 to 1.000, with higher scores indicating better health-related quality of life.	Baseline, 6 weeks, and 12 weeks
Goal Attainment	Individualized goal attainment will be assessed using Goal Attainment Scaling. Each goal will be rated on a 5-point scale from -2 to +2, where -2 indicates much less than the expected outcome, 0 indicates the expected outcome, and +2 indicates much more than the expected outcome. Higher scores indicate greater goal attainment.	Baseline, 6 weeks, and 12 weeks
Grip Strength	Grip strength will be assessed using a handgrip dynamometer. Grip strength will be recorded in kilograms, with higher values indicating greater muscle strength.	Baseline, 6 weeks, and 12 weeks
Two-Step Test	Physical function will be assessed using the Two-Step Test. The two-step value will be calculated by dividing the maximum length of two steps by the participant's height. Higher values indicate better physical function.	Baseline, 6 weeks, and 12 weeks
Pain Education Understanding	Understanding of pain education will be assessed using pain education understanding ratings.	Baseline, 6 weeks, and 12 weeks
Global Rating of Change	Participant-perceived overall improvement or worsening will be assessed using the Global Rating of Change Scale. Scores range from -5 to +5, where -5 indicates "very much worse," 0 indicates "no change," and +5 indicates "completely recovered." Higher scores indicate greater perceived improvement.	6 weeks and 12 weeks
Treatment Expectancy	Patient perceptions of treatment credibility and treatment expectancy will be assessed using the Credibility/Expectancy Questionnaire. The questionnaire includes treatment credibility items and treatment expectancy items. Scores for each factor range from 3 to 27, with higher scores indicating greater treatment credibility or expectancy.	Baseline

Collaborators and Investigators

• Sponsor: Prefectural University of Hiroshima
• Investigators: Principal Investigator: Tomohiko Nishigami, PhD, Prefectural University of Hiroshima

Study record dates

Study Major Dates

• Study Start (Estimated): August 1, 2026
• Primary Completion (Estimated): August 1, 2028
• Study Completion (Estimated): December 1, 2028

Study Registration Dates

• First Submitted: June 16, 2026
• First Submitted That Met QC Criteria: July 3, 2026
• First Posted (Actual): July 9, 2026

Study Record Updates

• Last Update Posted (Actual): July 9, 2026
• Last Update Submitted That Met QC Criteria: July 3, 2026
• Last Verified: July 1, 2026

More Information

Terms related to this study

• Keywords: Chronic pain; Nociplastic pain; Multimodal lifestyle approach
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Chronic Pain; Nociplastic Pain
• Other Study ID Numbers: 26MH005

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared because a data-sharing plan has not been established and data sharing would require additional ethical and institutional approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No