Search Results (64)

Background: Chronic low back pain (CLBP) is associated with psychological risk and resilience factors that drive pain, distress, and disability. Pain Resilience Therapy (PRT) is a novel strengths-based approach; however, its risk and resilience outcomes compared with recognized approaches remain unclear. Objective: To examine the effectiveness of PRT compared to Pain Neuroscience Education (PNE) on psychological risk and resilience factors in adults with CLBP. Design: Secondary data analysis from a randomized controlled trial. Methods: This secondary analysis included data from 60 adults with CLBP randomized to eight telehealth sessions of PRT or PNE delivered over four weeks. Psychological risk and resilience factors were assessed at baseline and at the 90-day follow-up using the OSPRO-YF, which estimates scores of 11 validated questionnaires across three domains: negative mood, negative/maladaptive coping, and positive affect/coping. Between-group differences were examined using ANCOVA with baseline adjustment. Treatment response was quantified using relative risk, absolute risk reduction, and number needed to treat. Results: PRT produced significantly greater improvements than PNE across eight of eleven outcomes, including anxiety, fear avoidance, pain catastrophizing, kinesiophobia, pain-related anxiety, self-efficacy for rehabilitation, and pain acceptance, with medium-to-large effect sizes (ηp² = 0.088–0.316). Both groups improved in depressive symptoms and pain self-efficacy. Trait anger did not significantly change in either group. The number needed to treat for PRT was 2 for self-efficacy for rehabilitation and 3 for pain catastrophizing, kinesiophobia, and pain acceptance. Conclusions: PRT demonstrated greater effectiveness across eight psychological risk and resilience factors than PNE, warranting further investigation in larger trials. Full article

Chronic pain is increasingly understood as a multidimensional condition in which, in a substantial subgroup of patients, a protective symptom can evolve into a persistent maladaptive disorder of the nervous system, while in others it may remain closely tied to ongoing mechanical or structural factors. Central sensitization (CS) represents a key mechanism underlying this transition, characterized by enhanced neural responsiveness and impaired endogenous pain inhibition, leading to a dissociation between pain and tissue pathology. The aim of this narrative review is to critically discuss current evidence on CS as a mechanism-based explanation for persistent pain, using lumbar disk herniation (LDH) as a clinical model of the radiological-clinical mismatch, and to discuss its direct implications for identifying sensitized phenotypes, multimodal assessment, and rehabilitation strategies. A total of 77 sources published between 2006 and 2026 were synthesized. These reviewed sources demonstrate that identification of the sensitized phenotype requires a multimodal assessment approach combining self-report measures, such as the Central Sensitization Inventory (CSI), with psychophysical methods including quantitative sensory testing (QST) and conditioned pain modulation (CPM). Cognitive-emotional factors are also critical, as postoperative kinesiophobia affects approximately 38.3% of LDH patients and is associated with increased pain intensity and reduced self-efficacy. Management strategies reported in these publications focus on mechanism-based interventions, particularly pain neuroscience education (PNE) and graded, time-contingent exercise, which aim to modify pain-related cognitions and restore endogenous inhibitory processes. These approaches may be supported by adjunctive therapies, including dry needling (DN), electro-dry needling (EDN), centrally acting pharmacological agents (e.g., serotonin–norepinephrine reuptake inhibitors [SNRIs] and gabapentinoids), and psychologically informed treatments such as cognitive behavioral therapy (CBT). While surgical decompression may reduce CS-related symptoms, preoperative sensitization does not necessarily predict poorer outcomes, highlighting the interaction between peripheral and central mechanisms. Adopting a sensitization-informed perspective may encourage a broader integration of contemporary pain models alongside traditional structural views in lumbar disc herniation clinical care. Full article

Chronic musculoskeletal pain and sarcopenia co-occur at rates exceeding epidemiological independence in older adults. However, no systematic review has examined whether exercise-induced myokine signaling suppresses shared NF-κB–driven inflammatory pathways to concurrently address chronic pain and sarcopenic muscle loss in older adults. Following PRISMA 2020 guidelines, we searched PubMed, Web of Science, Scopus, and Embase (January 2000–March 2026) and included 32 studies (RCTs, cohort, cross-sectional, and mechanistic designs) in adults aged ≥45 years with chronic musculoskeletal pain and/or sarcopenia; studies lacking an exercise component or human mechanistic relevance were excluded, and findings were qualitatively synthesized. The included studies suggest that persistent NF-κB hyperactivation—driven by SASP, LPS–TLR4 signaling, and mitochondrial ROS—is associated with both sarcopenic muscle loss and pain sensitization. Evidence from included studies indicates that contracting skeletal muscle secretes IL-6, IL-15, irisin, BDNF, and myostatin, which were frequently associated with suppression of NF-κB activity, attenuation of NLRP3 inflammasome activation, and improvement in pain inhibition—suggesting a hypothesized shared mechanistic pathway that awaits direct validation in trials enrolling older adults with co-confirmed sarcopenia and chronic pain. Multicomponent training emerged as the modality most consistently associated with concurrent benefits for both conditions across included studies. The synthesized evidence supports considering a two-phase approach—pain neuroscience education followed by progressive resistance training—as a hypothesis-driven framework to improve exercise adherence and myokine responses. These findings suggest that myokine signaling represents a plausible shared mechanistic pathway linking exercise to concurrent improvements in sarcopenia and chronic pain, warranting direct validation in future trials. Full article

Background/Objectives: Chronic pain in older adults is a highly disabling epidemic, often overtreated with passive pharmacological approaches. Although clinical guidelines recommend active strategies combining multicomponent exercise and Pain Neuroscience Education (PNE), robust geriatric evidence remains scarce. Therefore, the central objective of this randomized controlled trial (RCT) is to evaluate the efficacy of combined PNE and exercise versus exercise alone. Crucially, this RCT addresses a major literature gap by investigating the long-term dose–response effect of PNE (an 8-week intensive vs. a 32-week maintenance program) to determine the optimal strategy for sustaining behavioral change and pain relief. Methods: A prospective, single-blind RCT (1:1:1 allocation) will recruit 90 older adults (≥65 years) with primary chronic musculoskeletal pain. The 32-week intervention comprises three arms: a control group (multicomponent exercise), Intervention Group 1 (exercise + 8 weeks of PNE), and Intervention Group 2 (exercise + 32 weeks of PNE). The primary outcome is pain intensity (assessed via the Numeric Rating Scale [NRS]). Secondary outcomes include kinesiophobia, pain catastrophizing, chronic pain grade and related disability, quality of life, physical performance, body composition and analgesic consumption. Data collected at baseline, 8, and 32 weeks will be analyzed using mixed-effects models for repeated measures. Results: As this is a study protocol, there are no results to report yet. Upon completion of the trial, data will be analyzed using mixed-effects models for repeated measures to evaluate intra- and intergroup changes over time, and the findings will be disseminated in future publications. Conclusions: By evaluating the long-term dose–response effect, this study will determine the optimal PNE dosage required for sustained pain relief and behavioral change in older adults. If our hypotheses are confirmed, the findings will generate high-quality evidence to support the integration of combined active interventions into community settings, promoting active aging and reducing the burden of chronic pain. Trial Registration: ClinicalTrials.gov Identifier: NCT07287501. Full article

Background/Objectives: Chronic musculoskeletal pain is highly prevalent in primary care and is associated with impaired quality of life and increased healthcare utilization. Multimodal physiotherapy approaches combining pain neuroscience education and therapeutic exercise are recommended; however, evidence regarding their feasibility and medium-term effects in Spanish primary care remains limited. This pilot study aimed to evaluate the usefulness of a group-based multimodal physiotherapy program on health-related quality of life and other clinical outcomes. Methods: A multicenter, quasi-experimental pilot study with a pre–post design and 6-month follow-up was conducted in two primary care physiotherapy units in Spain. Adults with non-specific chronic musculoskeletal pain lasting ≥6 months participated in a 12-week group-based intervention combining pain neuroscience education and therapeutic exercise. Outcomes included health-related quality of life (SF-36), pain intensity (VAS), pain catastrophizing (PCS), kinesiophobia (TSK-11), central sensitization (CSI), analgesic consumption, healthcare utilization, and patient satisfaction. Intragroup changes, effect sizes, and minimal clinically important difference were analyzed. Results: Thirty-seven participants completed the program, with adherence > 80% and no adverse events. Significant improvements were observed at 6 months in all outcomes, with moderate to large effect sizes (SF-36, VAS, PCS). Between 54% and 78% of participants achieved minimal clinically important differences in key domains. Improvements were maintained at follow-up without clinically relevant deterioration. Conclusions: This pilot study suggests that a group-based multimodal physiotherapy program is feasible and potentially effective for managing chronic musculoskeletal pain in primary care. Larger controlled trials are warranted. Full article

Background: Pain neuroscience education (PNE) can support understanding of low back pain and facilitate engagement with active care. Most PNE materials have been developed in English, and there is little culturally adapted content for Urdu-speaking populations. Locally relevant educational resources may help improve clarity, acceptability, and communication in clinical settings. Objective: To develop, culturally adapt, and content-validate Urdu PNE materials for individuals with LBP and for use by healthcare professionals in Pakistan. Methods: A four-stage adaptation process was used. Phase 1 involved drafting a ten-module English PNE booklet and clinician guide based on contemporary pain-science literature. Phase 2 included forward–backward translation into Urdu and cultural adaptation by translators and a bilingual pain researcher. In Phase 3, three focus-group sessions with clinicians and a person with LBP informed iterative revisions. In Phase 4, a multidisciplinary panel (clinicians and individuals with LBP, n = 32) assessed seven domains of the final Urdu materials for clarity, relevance, and cultural appropriateness using Lawshe’s content validity ratio (CVR). Results: Focus-group feedback led to simplification of Urdu phrasing, refinement of metaphors, and adjustments to illustrations. All seven domains exceeded the minimum CVR threshold (0.30) for n = 32, with a mean overall CVR of 0.69 ± 0.12. Cultural appropriateness (CVR = 0.88) and content accuracy (CVR = 0.86) showed the highest agreement. Conclusions: The adapted Urdu PNE materials were judged to be clear, relevant, and culturally appropriate by clinicians and individuals with LBP. These materials may be useful for supporting pain-related education in clinical and community settings. These findings establish preliminary content validity; further studies are needed to evaluate feasibility, implementation, and clinical outcomes. Full article

Background/Objectives: Low back pain (LBP) is the leading cause of disability in Saudi Arabia and contributes substantially to healthcare utilisation, reduced quality of life, and lost productivity. This guideline provides nationally standardised, evidence-based recommendations for the assessment and management of non-specific LBP and sciatica in adults, adapted to the clinical and health-system context in Saudi Arabia. Methods: A multidisciplinary Task Force developed the guideline using the GRADE ADOLOPMENT approach, using NICE guideline NG59 as the primary evidence source. One additional clinical question was formulated to address pain neuroscience education, informed by a relevant systematic review. Update literature searches were conducted in PubMed, Embase, and the Cochrane Library (2016–2022). The evidence was appraised using GRADE, and recommendations were formulated through structured Evidence-to-Decision deliberations and consensus voting. Results: The Task Force addressed eleven clinical questions in this guideline. Strong recommendations were provided for the use of validated risk assessment tools (very low certainty of evidence) and stratified management (moderate certainty of evidence). Conditional recommendations were made for indications for imaging, pharmacological treatment for sciatica, psychological interventions, multidisciplinary return to work programmes, epidural injections, prognostic value of image-concordant pathology, spinal decompression, radiofrequency denervation, and pain neuroscience education, with certainty of evidence ranging from very low to low. Conclusions: The findings indicate that management of non-specific LBP and sciatica in Saudi Arabia should be guided by clinical assessment, with restricted use of imaging, careful selection of pharmacological treatments, and appropriate use of psychological, multidisciplinary, and procedural interventions. Full article

Background/Objectives: Biopsychosocial pain neuroscience education (PNE) has recently gained attention in preparing patients for surgery. PNE is expected to influence pain coping strategies and descending nociceptive inhibition. The goal of this study was to compare cortical evoked responses during experimental pain processing using a conditioned pain modulation (CPM) paradigm between patients receiving perioperative PNE (PPNE) or perioperative biomedical back school education (PBSE). Methods: This predefined EEG subgroup analysis included only participants with complete EEG recordings at baseline and 6 weeks. Of these, twenty-three patients with low back-related leg pain, scheduled for lumbar spine surgery, were randomized to either two sessions of PPNE or two sessions of PBSE. All patients were stimulated electrically at the median nerve of the symptomatic side and the sural nerve of the symptomatic and non-symptomatic side before and 6 weeks after the educational sessions, while evoked potentials were recorded by electroencephalography (EEG). Subsequently, this protocol was repeated during the application of the CPM paradigm by immersing the hand contralateral to the symptomatic side into cold water. Results: A significant decrease in the amplitude of the waveforms during CPM was found compared to the waveforms before CPM at the non-symptomatic sural nerve. No significant differences were found at the other test locations. For the waveforms of the CPM effect (subtracted waveforms), no significant treatment effects were revealed between the PPNE and PBSE groups. Conclusions: These exploratory findings suggest that PPNE was not associated with differential modulation of EEG evoked potentials during CPM compared with PBSE at 6 weeks post-surgery. Full article

Background and objectives: Pain neuroscience education (PNE) is a therapeutic strategy aimed at reconceptualizing pain in patients with chronic low back pain (CLBP). This systematic review with a meta-analysis (SRMA) aimed to assess the effectiveness of PNE in reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP at the end of the intervention, and at 1 and 3 months of follow-up. Materials and Methods: Following PRISMA guidelines, an SRMA was conducted after searching in PubMed Medline, Scopus, Web of Science, and PEDro databases from inception up to June 2025. The inclusion criteria agreed with the PICOS tool: population (patients with CLBP), intervention (PNE), comparator (physiotherapy or non-intervention), outcomes (pain, disability, kinesiophobia, and catastrophizing), and study design (randomized controlled trials (RCTs) and pilot RCTs). The PEDro scale was used to assess the methodological quality and risk of bias of the RCTs included. The pooled effect was assessed using the Cohen standardized mean difference (SMD) and its 95% confidence interval (95% CI) in a random-effects model. Results: Fifteen RCTs, including data from 810 patients (43.7 ± 5.2 years; 61% female) with CLBP were included. The mean methodological quality of the RCTs included was good (6.8 ± 1.1 on the PEDro scale). Selection, performance, and detection were the most important biases identified. Our meta-analysis demonstrated, at the end of the intervention, and at 1 and 3 months of follow-up, respectively, that PNE is effective in reducing pain intensity (SMD = −0.65, p = 0.005; SMD = −1.1, p < 0.001; SMD = −1; p < 0.001), disability (SMD = −0.6, p = 0.009; SMD = −0.78, p = 0.002; SMD = −0.84; p = 0.004), and kinesiophobia (SMD = −1.12, p < 0.001; SMD = −1.51, p < 0.001; SMD = −1.57; p = 0.001). In reducing catastrophizing, PNE was largely effective at the end of intervention (SMD = −0.9, p = 0.016) and at 1 month of follow-up (SMD = −1.36, p = 0.007). Conclusions: Our findings demonstrate that PNE is an effective therapeutic approach for the management of CLBP, reducing pain, disability, kinesiophobia, and catastrophizing in patients with CLBP. Full article

Background/Objectives: Pain neuroscience education (PNE) has demonstrated efficacy in adults with chronic pain, but the pediatric evidence is still developing, despite its increasingly frequent use. Evidence for the effectiveness of PNE in pediatrics remains fragmented across settings and outcomes, which justifies a systematic evaluation focused on children and adolescents. Methods: Following PRISMA, two reviewers independently screened records (PubMed, Web of Science, PEDro; through 21 July 2025), extracted data, and assessed risk of bias (RoB 2 for randomized controlled trials; NIH/CASP for non-randomized studies). Given the heterogeneity, we conducted a structured narrative synthesis (SWiM) and rated the certainty of evidence with GRADE. PROSPERO: CRD420251062922. Results: Eleven studies met the inclusion criteria. PNE consistently improved pain-related knowledge, with effects maintained at follow-up (moderate certainty); effects on pain intensity, function, and emotional outcomes were small and inconsistent (low certainty), with more favorable patterns when PNE was combined with exercise and/or booster sessions. Digital and gamified formats proved feasible and engaging; parental outcomes showed small improvements where measured. Conclusions: PNE is a promising, low-cost, and scalable component of pediatric chronic pain care, strengthening self-efficacy and adaptive coping. Integration into biopsychosocial, multidisciplinary programs—particularly alongside exercise and family involvement—may optimize outcomes. Larger, standardized trials with long-term follow-up and systematic adverse-event reporting are needed to solidify guidance for clinical practice. Full article

In sport, pain is often normalized, leading athletes to train or compete despite discomfort. This can shape their response to pain, with catastrophizing potentially triggering fear of movement, avoidance behaviors, and increased pain. While previous research has examined the relationship between pain and catastrophizing in individuals with chronic pain, few studies have explored these effects in the sports population. This study investigated the effects of a pain neuroscience educational program on catastrophizing and injury rates in youth female and male athletes. This parallel randomized trial included an intervention group (IG) and a control group (CG), both undergoing a 12-week program on healthy habits in sport. The IG received additional pain neuroscience information. Catastrophizing levels were collected before and after using the Pain Catastrophizing Scale. Injury rates were registered during the study. The results revealed a decrease in catastrophizing levels in the IG compared to baseline (p = 0.028, d = 0.32, 95%CI [0.03, 0.61]). In the IG, only males showed improvements (p = 0.041, d = 0.47, 95%CI [0.08, 0.86]). Injury rates were similar between groups (CG = 26.2%, IG = 27.8%; p > 0.05). Pain education may reduce catastrophizing in youth athletes, particularly males, although effects may vary by sex and context. Full article

Background/Objectives: Although pain education is a very important component of chronic pain management, its effects on primary dysmenorrhea (PD) have not been investigated. The aim of this study was to compare the effects of pain neuroscience education (PNE) or biomedical pain education (BPE) combined with exercise training (ET) in PD. Methods: Individuals with PD were randomly assigned to PNE or BPE combined with ET (stretching and relaxation exercises) for two menstrual cycles. The PNE focused on pain neurobiology, central sensitization, and brain pain-modulation mechanisms, while the BPE included anatomical and biomechanical explanations of pain. Assessments were conducted at the start of the study, after the intervention period, and at the one-month follow-up after the intervention. The primary outcome measure was menstrual pain (mean and maximum pain) intensity, while the secondary outcome measures included menstrual stress, central sensitization symptoms, and pain catastrophizing. Results: All the individuals assigned to the PNE+ET (n = 19) and BPE+ET (n = 19; control) groups were included in the analysis. PNE or BPE with ET led to improvements in all outcome measures (p < 0.05). Furthermore, PNE was found to reduce menstrual pain, central sensitization symptoms, and pain catastrophizing more after the intervention and at follow-up compared to BPE (p < 0.05, Cohen’s d = 0.683–1.174). However, menstrual stress decreased at similar levels in both groups (p > 0.05). Conclusions: The combination of PNE or BPE with ET was demonstrated to be an effective approach for the management of menstrual pain and stress in PD. Furthermore, PNE appears to be more efficacious in addressing menstrual pain, symptoms of central sensitization, and pain cognition compared with BPE. Further studies could investigate the combination of PNE with different education parameters and physiotherapy methods to manage PD. Full article

This review explores pain neuroscience education (PNE) in the context of opioid dependence among Caucasian and African American populations, addressing disparities and sociocultural influences in the opioid epidemic. Von Bertalanffy’s general systems theory and Bronfenbrenner’s ecological systems theory comprise the underlying theoretical frameworks behind the review, emphasizing the importance of biopsychosocial perspectives of chronic pain and ecological systems on individual development. Within these frameworks, the study objective is to summarize relevant and contemporary literature among African American and Caucasian populations regarding opioid dependency, neuroplasticity in chronic pain, and PNE. Peer-reviewed articles published within the last 10 years were reviewed for relevance. Limitations include a lack of research on the intersection of ethnicity and PNE, a lack of studies investigating interdisciplinary input regarding PNE, and a focus on only two ethnic groups. This narrative review finds that African Americans face systemic barriers to effective treatment for pain and opioid use disorder (OUD), while Caucasians are more likely to be overprescribed with higher rates of OUD. From a systems and ecological perspective, maladaptive neuroplasticity in chronic pain (biologic subsystem) intersects with ethnic disparities in prescribing access and pain beliefs (psychosocial subsystem) to influence opioid use and the chronic pain experience. PNE shows promise as an adjunct to traditional physical therapy in reducing nociplastic pain, potentially affecting opioid dependency. Future research should incorporate readiness-to-change models, generational and ethnocultural perspectives, and neuroimaging with PNE to optimize the delivery of PNE to individuals of different backgrounds. Full article

Background: Pain neuroscience education (PNE), when combined with physical therapy interventions, has been recognized as an effective strategy for improving pain management and reducing disability in individuals with chronic pain. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in combination with rehabilitation modalities, with a focus on pain reduction and functional improvement. Methods: A comprehensive systematic search was conducted in Cochrane, PsycInfo, PubMed, ScienceDirect, Scopus, and Web of Science databases to identify randomized clinical trials examining the effects of combining PNE with physical therapy. Nineteen studies met the inclusion criteria. Data extraction focused on demographic and methodological characteristics, as well as outcomes related to pain and disability. Results: The findings indicate that PNE combined with physical therapy significantly reduces pain intensity and enhances functionality. The mean pain score decreased from 5.89 (pre-intervention) to 3.03 (post-intervention), with similar improvements observed in disability outcomes. However, heterogeneity among studies—attributable to sociocultural and methodological differences—suggests the need for a cautious interpretation of the results. Conclusions: The integration of PNE with physical therapy appears to be an effective approach for reducing pain and improving functional outcomes in patients with chronic pain. Nevertheless, further research is recommended to address existing heterogeneity and to refine standardized intervention protocols. Full article

Chronic migraine (CM) is a highly disabling condition, affecting about 2% of the global population. Non-pharmacological treatments can be optimal for their non-invasive nature. This prospective, randomized, double-blind, controlled trial aimed to test the efficacy of therapeutic neuroscience education (TNE) in CM. Early response biomarkers were also evaluated. A total of 80 CM patients were consecutively enrolled and randomly allocated to TNE or a general education program. Treatment effectiveness was evaluated at baseline (T1) and 2 months after the end of treatment (T4). We collected the responses to disability and comorbidity questionnaires at the start (T1) and end of treatment (T3, 10 weeks after start). Early response biomarkers were evaluated at screening (T0) and mid-way through the process (T2, 5 weeks after start). We expected that TNE would provide a greater benefit than the general education program, which served as the primary outcome of this study. We also expected that a change in clinical and neurophysiological measures could potentially occur, reflecting plasticity-induced reorganization and predicting clinical response. This is the first study selectively exploring the effect of TNE as a standalone treatment for CM. A new, effective treatment regime without interactions with other medication could be of great interest as an addition to migraine therapeutic strategies. Full article