PNE · Method
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Method · evidence · application

Pain neuroscience education.
A method with a dose.
And a clear limit.

PNE changes the concept of pain: from a marker of damage to a signal of protection. Alone, it moves pain very little. Added to exercise, meta-analyses show about 1 point on a 0 to 10 scale in the short term, with low to moderate certainty. About 200 minutes are associated with exceeding the MCID for pain and about 150 minutes for disability. Against another active education, the better controlled trials are usually null on the primary outcome. Change in knowledge is not associated with pain (r = -0.01).

Start with the method See the dose
200minutes of PNE added to exercise that exceed the MCID for pain
150minutes that exceed the MCID for disability
-0.01correlation between change in knowledge and short-term pain
91sources with a DOI or link checked on 30 October 2026

Pain and disability: Núñez-Cortés et al., 2024, Pain. Correlation: Ram et al., 2023, 14 studies and about 1,500 people. The interval and the sign of each figure are in Evidence.

01 / WHAT IT IS

An education that changes the concept of pain.

Pain neuroscience education (PNE) is an educational intervention. It aims to change the concept of pain: from a marker of damage to a signal of the perceived need to protect tissue.

Definition

Moseley and Butler (2015) call it Explaining Pain. It uses conceptual-change strategies. The authors are clear that it is not behavioural or cognitive advice, and that it does not deny nociception. In that paper it increases knowledge, reduces catastrophising, and comes with short-term reductions in pain and disability.

The literature uses equivalent names: pain neuroscience education (PNE), therapeutic neuroscience education, pain science education (PSE), pain neurophysiology education and Explaining Pain. Reviews use them interchangeably. Bonatesta et al. (2022) and Núñez-Cortés et al. (2024) say PSE.

Origin

The first reference randomised trial is Moseley et al. (2004, The Clinical Journal of Pain), in chronic low back pain. Education changed attitudes (SOPA(R)), catastrophising (PCS), straight leg raise and forward flexion. The change in the RMDQ was small. The authors concluded that education alone was insufficient. The abstract gives no n, no sessions, no minutes and no number for the RMDQ.

The same year, Moseley (2004, European Journal of Pain) analysed 121 patients. Cognitive change correlated with physical change: r = 0.88 with straight leg raise and r = 0.79 with forward flexion.

The founding reviews are Louw et al. (2011), 8 studies and n = 401, a narrative synthesis, and Louw et al. (2016), 13 RCTs. In the sources used here, those two reviews do not provide a pooled effect this page can cite.

Where it sits

Model

Biopsychosocial

PNE is an educational tool inside the biopsychosocial model. It is not the whole model.

Not PNE

Cognitive functional therapy

CFT (O'Sullivan et al., 2018) is an integrated behavioural approach: making sense of pain, exposure with control, and lifestyle change. It includes a reconceptualisation close to PNE and joins it to exposure and behaviour change. That integration is what the data on PNE alone leave open.

The RESTORE trial (Kent et al., 2023, Lancet, n = 492) tested CFT, not stand-alone PNE. At 13 weeks the RMDQ was MD -4.6 (CI -5.9 to -3.4) with CFT and MD -4.6 (CI -5.8 to -3.3) with CFT plus biofeedback. The effect held at 52 weeks. The social saving was about AU$5,276 per person. Thiveos et al. (2024), 7 RCTs, report low to moderate certainty for pain and disability and high certainty for self-efficacy. The source does not give the effect size of that meta-analysis.

Louw et al. (2021, JOSPT) place PNE as an adjunct to exercise and movement for the patient, and as a central focus of clinician training. Nijs et al. (2020) propose integrating it with motivational interviewing. That paper is a practical guide, with no efficacy data, and the authors ask for trials.

02 / HOW IT WORKS

Threat falls. The quiz does not carry the outcome.

The theory is a chain: perceived threat falls, catastrophising and fear of movement fall, activity and exposure rise, and pain and disability fall with them. Mediation analyses test that chain.

RESOLVE: what mediated

Cashin et al. (2023) mediated the RESOLVE trial (Bagg et al., 2022): 276 adults with chronic low back pain, education plus graded sensorimotor retraining versus sham. Four of 7 variables mediated pain and 5 of 7 mediated disability. Together they explained most of the effect. The abstract does not name the ones that dropped out.

The dot is drawn in the direction that favours PNE, so papers that publish the opposite sign can be read on one axis. The number on the right is the original estimate, with each paper's own sign. Cyan bar: the CI lies on the side that favours PNE. Copper bar: the CI includes 0. Dot without a bar: the source gives no CI.

On pain

On disability

In RESOLVE itself, pain at 18 weeks was -1.0 (CI -1.5 to -0.4) versus sham, with 12 weekly sessions (Bagg et al., 2022). Venter et al. (2026) found no clear effect modifiers. Self-perception of the back was a possible modifier (β 0.18).

PREVENT: acute pain

Cashin et al. (2022) mediated PREVENT (Traeger et al., 2019, JAMA Neurology, n = 202): 2 hours of education versus placebo education in high-risk acute low back pain. Catastrophising mediated, -0.64 (CI -1.31 to -0.15), as did back beliefs, -0.51. Self-efficacy did not. To gain 2 RMDQ points, the MCID in that analysis, it would take 8 PSEQ points, 11 BBQ points or 21 PCS points. Those are large changes.

The trial itself found pain at 3 months of -0.3 (CI -1.0 to 0.3). Disability was -1.6 at one week (CI -3.1 to -0.1) and -1.7 at 3 months (CI -3.2 to -0.2). There were no differences at 6 or 12 months.

The quiz is not the mechanism. Ram et al. (2023) pooled 14 studies and about 1,500 people. In the short term, change in pain neurophysiology knowledge was not associated with outcomes: pain r = -0.01 (CI -0.14 to 0.13), very low certainty; kinesiophobia r = 0.02; catastrophising r = -0.03, low certainty. What seems to count is changing beliefs about consequences and threat, and carrying that into behaviour.

Other paths

Murillo et al. (2023), in PNE plus exercise, found that kinesiophobia and distress linked to central sensitisation mediated disability and medication use. Catastrophising and pain intensity did not. The source does not give the size of those indirect effects.

Alalawi (2026) reanalysed the Indian RCT of Sidiq et al. (2024). In 46 participants who received education plus physiotherapy, emotional wellbeing (WHO-5) had a mediated causal effect of -1.66 (CI -2.8 to -0.72), about a quarter of the effect on disability. Self-efficacy did not mediate. No mediator explained pain. The recovery trajectories from the same material are in the Saudi section: the author is Saudi and the data are from India.

Núñez-Cortés et al. (2024, Neuroscience & Biobehavioral Reviews) analysed 11 studies. The number of target concepts was associated with change in pain (F = 4.45; p = 0.04; R² 26.07%). Only two concepts had their own effect on pain: transferring knowledge into an adaptive behaviour change, and pain reconceptualisation. No concept had an effect on disability.

Di-Bonaventura et al. (2025) compared 3 hours of PNE with a booklet in 66 participants. Plasma BDNF did not change (p = 0.708). Both groups improved on pain: PNE d = 0.70 and booklet d = 0.39.

What people say after receiving it

  • Rizzo et al. (2024), n = 20, after an education-based intervention: the themes included "are you suggesting my pain is not real?", "my pain is different", and doubt about how to carry it into daily life.
  • Ciolan et al. (2025), 9 studies and 188 participants, moderate confidence: effective communication, emotional support and empowerment.
  • Kühn et al. (2026), 16 studies and 329 participants, 6 synthesised findings. The source used here does not list those six findings.
  • Watson et al. (2019), in the metasynthesis: letting the patient tell their story helps reconceptualisation.
A neighbouring field, with large effects. Pain Reprocessing Therapy (Ashar et al., 2022, n = 151) goes beyond classical PNE. Versus placebo, g -1.14. Versus usual care, g -1.74. Pain-free or nearly pain-free: 66% with PRT, 20% with placebo and 10% with usual care. At one year: g -0.70 and -1.05. This is not pure PNE. It shows where the field is heading: reconceptualisation with exposure and active reappraisal.

Reading. Passing the knowledge quiz is not the mechanism. The chain that does appear in the mediation analyses runs through threat beliefs and behaviour.

03 / HOW IT IS DONE

Content, format and minutes.

Doing PNE means choosing a format, a content and a dose. The reviews do not agree on a single moderator, and the figures below stay with the outcome each review measured.

Formats

Group

In Romm et al. (2021) the group format moderated the effect on kinesiophobia (d = 0.80; CI 0.09 to 1.50). In that review, dose did not moderate the effect. In Ma et al. (2024) the group subgroup had a pain MD of -1.76. Salazar-Méndez et al. (2024, PeerJ) is only a protocol comparing group and individual delivery (n = 69). There are no results yet.

Online

de Oliveira Lima et al. (2021), 6 trials and n = 1,664, studied self-guided web education. Pain: SMD -0.23 in the short term and -0.26 in the medium term. Disability: -0.36. No added benefit over usual care. García-Lucas et al. (2026) tested 12 audiovisual lessons for pregnancy-related lumbopelvic pain (n = 211): pain MD -0.5 (CI -1.0 to 0.0) and kinesiophobia MD -1.4 (CI -2.3 to -0.4).

Virtual reality

McConnell et al. (2024) ran a feasibility study: 52 people enrolled, 32 completed, with no between-group differences. The full-text extraction puts the mean session at about 21 minutes. The number of sessions varied by therapist, so total minutes cannot be calculated.

Single session

Tomás-Rodríguez et al. (2024), n = 121, added 60 minutes of PNE to a back school. Pain did not fall. The CSI and the PCS did improve at 12 weeks.

Metaphors

Louw et al. (2019) surveyed clinicians: 19 of 27 responded (70%). Six of 11 metaphors had a mean above 3, and none stood out clearly. There is no winning metaphor. It is chosen with the person.

Doses that exceed the MCID

Núñez-Cortés et al. (2024, Pain) pooled 26 RCTs and n = 1,852, with PNE added to exercise for chronic spinal pain. The effect of exercise alone was small. The source does not give the figure for that small effect. Salazar-Méndez et al. (2023) pooled 23 studies and n = 2,352. Doses ranged from 40 to 720 minutes and the dose-effect relationship was linear. Each card is a different outcome. They are not added together.

Kinesiophobia100 min

MD -8.53. Exceeds the MCID. No CI in the source.

Salazar-Méndez et al. 2023
Disability150 min

Estimate -6.84 (CI -7.98 to -5.70), added to exercise. Exceeds the MCID.

Núñez-Cortés et al. 2024, Pain
Pain200 min

Estimate -2.61 (CI -3.12 to -2.10), added to exercise. Exceeds the MCID.

Núñez-Cortés et al. 2024, Pain
Anxiety200 min

MD -1.88. Exceeds the MCID. No CI in the source.

Salazar-Méndez et al. 2023
Catastrophising400 min

MD -7.17. Exceeds the MCID. No CI in the source.

Salazar-Méndez et al. 2023

Minutes on the observed range, 40 to 720 (Salazar-Méndez et al., 2023).

Pain subgroups in Ma et al. 2024

A negative sign favours PNE. In the meta-regression, only the length of each session was associated with greater pain reduction. The source does not publish the coefficient of that meta-regression.

SubgroupPain MD
Single session longer than 60 min-2.04
Group format-1.76
4 to 8 sessions-1.34
7 to 12 weeks-1.32

Content

  • Reconceptualise: pain as protection, not as damage (Moseley and Butler, 2015).
  • Close each block with a translation into behaviour: what to do differently this week. That concept, with reconceptualisation, was one of the two with its own effect on pain (Núñez-Cortés et al., 2024).
  • Work on beliefs about the consequences of back pain, the largest mediator in RESOLVE (Cashin et al., 2023).
  • Avoid "injury", "degeneration" and "wear" (KNGF 2021). Say explicitly that the pain is real (Rizzo et al., 2024). Let the person tell their story (Watson et al., 2019).

What to measure

The rNPQ shows whether the content was understood. Ram et al. (2023) show that this knowledge change does not predict short-term pain, so it is not the clinical target.

InstrumentWhat it measuresPublished dataArabic version
NPQ y rNPQKnowledge of pain neurophysiologyCatley et al. 2013: Rasch analysis, n = 300, 7 problematic items. That is the source of the rNPQ.No Arabic validation turned up in this search. Alhowimel et al. 2021 used the rNPQ with Saudi physiotherapists.
COPI-AdultConcept of painPate et al. 2022: n = 627, 13 items, α = 0.78, ICC 0.84 (0.71 to 0.91).No Arabic validation turned up in this search.
TSKKinesiophobiaThe sources used for this page do not report a psychometric figure for the generic scale.TSK-AV-11, validated in Jordan (Al-Shudifat et al. 2020): n = 101, 2 factors explaining 46.54% of the variance.
PCSCatastrophisingThe sources used for this page do not report a psychometric figure for the generic scale.Arabic version (Terkawi et al. 2017): n = 113, α = 0.94, ICC 0.83.
CSICentral sensitisation symptomsThe sources used for this page do not report a psychometric figure for the generic scale.Saudi version (Tamboosi et al. 2024): n = 264 plus 56 controls, α = 0.919, ICC 0.874. Another Arabic version (Madi et al. 2022): α = 0.88, ICC 0.94, MDC95 9.57.
04 / HOW IT IS APPLIED

Always with exercise or with active work.

In clinic, PNE is used with exercise or with other active work. JOSPT 2021 summarises that none of the studies of PNE alone improved pain, and that 5 of 6 studies that combined it with exercise or manual therapy did reduce pain.

A practical proposal, not a validated programme. The eight steps come from the sources cited on each line. Nobody has tested this package, as written here, as a single intervention.
  1. Who. Persistent pain for more than 3 months, especially with high kinesiophobia or catastrophising, or with a high risk of chronicity.This is how the 2026 Saudi guideline and KNGF profile 3 set the priority.
  2. Never alone. Always joined to exercise or to active work.JOSPT, grade A. No stand-alone PNE improved pain in that guideline's summary.
  3. Dose. Aim for about 150 minutes in total for disability and about 200 minutes for pain.Núñez-Cortés et al., 2024, Pain. Sessions of 60 minutes or longer when possible (Ma et al., 2024). Group format is an option and saves clinician time (Romm et al., 2021; Ma et al., 2024).
  4. Content. Reconceptualise pain as protection and close each block with a behaviour for that week.Núñez-Cortés et al., 2024. Beliefs about the consequences of back pain: Cashin et al., 2023.
  5. Language. Avoid injury, degeneration and wear. Validate that the pain is real. Let the person tell their story.KNGF 2021. Rizzo et al., 2024. Watson et al., 2019.
  6. Metaphors. Choose them with the person. None is superior.Louw et al., 2019. Cultural adaptation into Arabic is in Najem et al., 2025, and Basalem et al., 2025, in the Saudi section.
  7. Measure at the start and at 6 to 12 weeks: NRS, a region-specific disability scale, TSK-11 and PCS. The rNPQ stays as a comprehension check.Arabic versions of the TSK, PCS and CSI are in the table in the previous section. Ram et al., 2023.
  8. Expectation. A larger change in kinesiophobia than in pain is what the trials show. A minority respond.Watson et al. (2021) estimate that the proportion of people who respond runs from 18% to 45%. There was not enough evidence of true between-person differences in response.
05 / EVIDENCE

The comparator decides the result.

The comparison changes the result. Added to exercise or physiotherapy, meta-analyses show about 1 point on a 0 to 10 pain scale in the short term, with low to moderate certainty. Against another credible active education, the better controlled trials are mostly null on the primary outcome.

Pain, 0 to 10

The dot is drawn in the direction that favours PNE, so papers that publish the opposite sign can be read on one axis. The number on the right is the original estimate, with each paper's own sign. Cyan bar: the CI lies on the side that favours PNE. Copper bar: the CI includes 0. Dot without a bar: the source gives no CI. Wood and Hendrick publish a positive sign in favour of PNE. Ma, Cancela and Siddall publish a negative sign in favour of PNE.

Disability, fear and catastrophising

Siddall et al. (2022) is PNE plus exercise versus exercise. Medina-Viedma et al. (2025) compare with physiotherapy or with no intervention: the mixed comparator inflates the effect. Cancela et al. (2025) do not find a significant effect on disability.

The dot is drawn in the direction that favours PNE, so papers that publish the opposite sign can be read on one axis. The number on the right is the original estimate, with each paper's own sign. Cyan bar: the CI lies on the side that favours PNE. Copper bar: the CI includes 0. Dot without a bar: the source gives no CI.

A 0 to 100 scale

The dot is drawn in the direction that favours PNE, so papers that publish the opposite sign can be read on one axis. The number on the right is the original estimate, with each paper's own sign. Cyan bar: the CI lies on the side that favours PNE. Copper bar: the CI includes 0. Dot without a bar: the source gives no CI.

Further figures from the same lines of evidence

SourceOutcomePublished figure
Wood and Hendrick 2019Disability. The source does not name the scale of this 0.42.0.42 (CI 0.28 to 0.56). With physiotherapy: 3.94 (CI 3.37 to 4.52). No long-term effect.
Tegner et al. 20187 RCTsPain: MD -1.03 at the end and -1.09 at 3 months. Disability: SMD -0.47 and -0.38. TSK not significant. No CI in the source.
Ma et al. 2024Disability. 17 RCTs, n = 1078.PNE plus exercise: SMD -0.80 (CI -1.13 to -0.47). PNE plus physiotherapy: SMD -0.85. The second value has no CI in the source.
Medina-Viedma et al. 2025At 3 months. Mixed comparator.Pain SMD -1.0. Disability -0.84. Kinesiophobia -1.57. No CI in the source.
Siddall et al. 2022Catastrophising-7.72. No CI in the source.
Bonatesta et al. 2022Pain. 8 RCTs, 5 in the meta-analysis.SMD -0.53 in the short term and -0.57 in the medium term. Low to very low certainty. No CI in the source.
Khan et al. 2026Sleep and psychosocial variablesTotal sleep time 0.42. The source does not name the metric. No effect on the psychosocial variables.
Tatikola et al. 2025, PNE+20 studies in the meta-analysisVAS SMD -0.70. NPRS -1.71. TSK -5.29. PCS -3.82. No CI in the source.
Lin et al. 2024Neck. 7 RCTs, n = 479.Pain g -0.730 (CI -1.340 to -0.119), I² 89%. Kinesiophobia g -0.444. Effective in adults and not in adolescents.
Saracoglu et al. 2022Fibromyalgia. 4 studies, n = 612.FIQ SMD -1.051. Pain -1.049.
Suso-Martí et al. 2022Fibromyalgia. 8 studies.Pain SMD -0.76 (CI -1.33 to -0.19), I² 92%, low quality. No effect on catastrophising or anxiety.
Lesmond et al. 2024Knee osteoarthritis. 7 studies.Pain MD -0.49 (CI -0.66 to -0.32). Catastrophising -1.81, no CI in the source.
Sidiq et al. 2024Chronic low back pain, India. n = 92, 6 weeks. Retrospective registration.Disability MD 8.2 (d = 0.75). Pain MD 3.5 (d = 0.82). Effects much larger than those of the meta-analyses.

Hurley-Wallace et al. (2025), in a component network meta-analysis of knee or hip osteoarthritis, describe little or no effect on pain or function, benefits on the psychological variables, and a worse outcome when PNE is used alone. The source does not give a numeric estimate for that "little or no effect". Escriche-Escuder et al. (2023) scoped tendinopathy: 5 studies, n = 164, with no pooled effect.

Delgado-Gil et al. (2025), shoulder, n = 55, four 75 minute sessions added to manual therapy and exercise. The abstract reports a significant interaction for range of motion, disability, catastrophising, kinesiophobia and therapeutic alliance. The abstract extraction gives the disability interaction F = 6.14, p = 0.01; TSK F = 7.62, p = 0.008; PCS F = 8.79, p = 0.01. Pain is not among the significant interactions. These are not mean differences.

Louw et al. (2014), preoperative PNE for lumbar radiculopathy: no difference in pain or function at one year, and a better surgical experience. The abstract gives P = 0.183 for low back pain, P = 0.075 for leg pain and P = 0.365 for the ODI at 12 months, in 67 people with outcomes. The randomised n is not in the abstract. Healthcare use favoured PNE (P = 0.007).

Huysmans et al. (2023), lumbar surgery, n = 120: pain was not better at 12 months. There were gains on the SF-36 physical score, an additional decrease of 3.15 on the TSK (CI 0.25 to 6.04) and of 6.18 on the PCS (CI 1.97 to 10.39), and a cost-effective result of -€2,732.

Salazar-Méndez et al. (2024), preoperative PNE for arthroplasty: only 2 studies of knee replacement, n = 147.

Trials with an active comparator

The primary outcome of these trials did not favour PNE with an interval that excluded 0. Malfliet et al. (2025) compare a package (PNE, stress management and cognition-targeted exercise) with usual physiotherapy, not PNE alone. Larsen et al. (2024) give PNE in both arms and test the added exercise. In Dams et al. (2023) the value -1.31 corresponds, in the abstract extraction, to a smaller improvement with PNE (change 4.22 versus 5.53).

TrialnPrimary resultP
PREVENT, Traeger et al. 2019. High-risk acute low back pain. Placebo education.202Pain at 3 months, MD -0.3 (CI -1.0 to 0.3).n.s.
Chimenti et al. 2023. Achilles tendinopathy. Both groups exercised. Pathoanatomical education.66No difference in movement-evoked pain.
Dams et al. 2023. After breast cancer surgery. Biomedical education.184-1.31 (CI -5.28 to 2.65) on change in the Pain Disability Index.0.516
Larsen et al. 2024. Chronic pain after knee arthroplasty. Exercise plus PNE versus PNE alone.69KOOS4, MD -1.33 (CI -7.59 to 4.92).0.68
Baas et al. 2024. Knee arthroplasty. Usual care. The abstract does not state the sign direction.68WOMAC pain 0.4 (CI -1.7 to 2.4).n.s.
Adenis et al. 2024 and 2026. Low back pain in multidisciplinary rehabilitation. Spinal physiology and ergonomics education.88; 74 at 12 monthsDisability at the end -1.7 (CI -4.0 to 0.5). At 12 months -1.04 (CI -3.14 to 1.06).0.12; 0.33
Malfliet et al. 2025. Chronic whiplash. Physiotherapy with biomedical education. Positive difference favours the PNE package.120NDI at 6 months, MD 2.38 (CI -0.12 to 4.89).0.15

What does move in that group of trials: TSK-17 -3.97 (CI -7.36 to -0.58) at 12 months (Adenis et al., 2026); the TSK and PCS from Huysmans et al. (2023), cited above; pain-free at the end, 23.3% versus 5.0% (Malfliet et al., 2025). In Malfliet the NDI also differed at the end, 3.55 (CI 1.12 to 6.26), P = 0.006, and at 12 months, 3.54 (CI 0.81 to 6.28), P = 0.02. The 6 month primary did not. The reported saving is US$854.01. The positive sign in that trial favours the package that includes PNE.

For

Meta-analyses of PNE added to exercise give about 1 point on a 0 to 10 pain scale and moderate to large effects on kinesiophobia. In the dose reviews, the number of minutes has a coherent relationship with the effect.

Against

Cuenca-Martínez et al. (2023), an umbrella review of 16 reviews: stand-alone PNE is not significant and the reviews are of critically low quality. Riley et al. (2026): only 5 high-integrity RCTs, and no reliable evidence that PNE adds to a specific physical intervention on pain or function. Ram et al. (2023): knowledge is not associated with outcomes. When the comparator is another active education, the effect on pain and function drops away and kinesiophobia is what often remains.

Reading. PNE works as content inside an active intervention. A specific advantage of the neuroscience content over a good education that is not neuroscience is not shown for pain or function.

Limits that remain open

  • There are few comparisons against a credible active education with 12 month follow-up.
  • Long-term effects on pain and function are inconsistent. Wood and Hendrick (2019) find no long-term effect.
  • It is unknown which component is doing the work: content, alliance, exposure or dose.
  • Evidence in athletes is very thin. The volleyball trial in the New section is small and retrospectively registered.
  • There are no data on sex and the hormonal cycle in the response to PNE. Holmes et al. (2026) set this as an agenda, in an editorial, not in a trial.
  • Review quality is low (Cuenca-Martínez et al., 2023) and RCT integrity is doubtful (Riley et al., 2026).
06 / WHAT IS NEW

What was published from 2024 to 2026.

From 2024 to 2026 the field sharpened dose, target concepts and comparisons against active education. The figures for each paper are in Dose, in How it works or in Evidence. This section is the map, with no new numbers.

2024

Dose and target concepts (Núñez-Cortés et al.). Short-term low back pain (Ma et al.). A single session (Tomás-Rodríguez et al.). Virtual reality, feasibility (McConnell et al.). An Indian trial later reanalysed by Alalawi (Sidiq et al.).

2025

An umbrella review in low back pain (Cancela et al.). Low back pain with a mixed comparator (Medina-Viedma et al.). Knee or hip by components (Hurley-Wallace et al.). PNE+ (Tatikola et al.). Whiplash (Malfliet et al.). Shoulder (Delgado-Gil et al.). BDNF (Di-Bonaventura et al.). Qualitative work (Ciolan et al.).

2026

RCT integrity (Riley et al.). Sleep and psychosocial variables (Khan et al.). 12 month follow-up (Adenis et al.). Pregnancy, online (García-Lucas et al.). Qualitative work (Kühn et al.). Cultural feasibility in India (Ganapathy et al.), with no abstract available and no figures to cite.

Sport

Koç and Dengiz (2026) studied elite volleyball players with chronic shoulder pain: 16 with PNE and 24 in the control group, 12 sessions of 45 minutes over 6 weeks. PCS partial eta squared 0.76. Resting pain partial eta squared 0.42. Retrospective registration and a small sample. Maguire et al. (2019) gave one 70 minute session to 61 sports therapy students and knowledge improved, MD 3.2 (CI 2.1 to 4.3). That is training, not a patient trial. Holmes et al. (2026, BJSM) is an editorial on pain neuroscience in the female athlete: hormones, pelvic pain and descending modulation. It is not a trial.

A protocol, still without results

Morales-Osorio et al. (2026) published the FIBROIA protocol: telerehabilitation with artificial-intelligence-guided exercise plus PNE for fibromyalgia, 50 participants planned, in Latin America.

07 / GUIDELINES

From grade A to no recommendation.

Guidelines that name PNE tie it to another intervention, or they leave it conditional. NICE does not name it. The code column is a proposal on this page so the rows can be compared at a glance. It is not an official scale.

GuidelineWhat it says about PNEStrengthProposed code
JOSPT 2021, George et al.Provide PNE with exercise or manual therapy for chronic low back pain. Use active treatment rather than stand-alone education.Grade A4
OMS 2023Structured, standardised education or advice as part of care. It does not name PNE as its own recommendation. Pain neuroscience content was present in 7 of 15 trials in the evidence.Conditional for, very low certainty2
KNGF 2021Overweeg (consider) pain education, in addition to information, for profile 3, for example with unrealistic fear of movement or catastrophising. Avoid injury, degeneration and wear.Weak: consider1
NICE NG59, 2016, updated July 2026Does not name PNE. Recommendation 1.2.1, still in force, asks clinicians to give information on the nature of low back pain as part of self-management. In July 2026 the recommendations on psychological therapy and on combined physical and psychological programmes were withdrawn.No PNE recommendation0
Saudi Arabia 2026, Aldera et al.Suggests using PNE for chronic non-specific low back pain and prioritising it when the risk of disability and chronicity is higher.Conditional for, low certainty2

Proposed code, not official, taken from the working coding: 4 for grade A, 2 for conditional, 1 for consider, 0 for no PNE recommendation. JOSPT and the Saudi guideline talk about PNE. WHO and NICE talk about education, with the nuance in each row.

July 2026 and NICE NG59. Recommendation 1.2.1 remains in force and asks clinicians to give information on the nature of low back pain as part of self-management. Recommendations 1.2.13 and 1.2.14, on psychological therapy and on combined physical and psychological programmes, were withdrawn because those areas were not prioritised for update. The 2026 Saudi guideline was adapted from NG59 before that withdrawal.

JOSPT 2021 covers RCTs up to 1 July 2020. Standard education receives grade B, and not as a stand-alone treatment. The 2012 guideline already asked, at grade B, to emphasise the neuroscience that explains pain perception. The 2021 grade A is for giving PNE together with exercise or manual therapy, and for preferring active treatments over stand-alone education.

The KNGF row summarises the full text of the 2021 Dutch guideline (Overweeg, profile 3). Apeldoorn et al. (2024) is the journal paper of that guideline in the European Journal of Physical and Rehabilitation Medicine. On this page the clinical detail comes from the guideline text, not from new figures in that paper.

08 / SAUDI ARABIA

An annex, not the centre of the method.

This section is an annex. The method is in the sections above. Here are the Saudi recommendation, what is published on Saudi physiotherapists' knowledge, and a reanalysis by a Saudi author of a trial conducted in India.

Annex

The 2026 Saudi guideline

Aldera et al. (2026) answer question 3.11 on chronic non-specific low back pain. The guideline suggests using PNE and prioritising it for people at higher risk of disability and chronicity. The recommendation is conditional for, with low certainty. The evidence base is Wood and Hendrick (2019). The update search found no new studies. No adverse events were reported.

For the Saudi context, the guideline judged PNE probably not acceptable because it might increase the clinician's workload, although it cites a feasibility trial (GLITtER) that supported acceptability. It judged PNE feasible with training. Telehealth might improve access. There is a concern about equity in rural areas. GLITtER is not among the 91 sources on this page: it is named only as the guideline cites it.

Table 22. A positive sign favours PNE

OutcomeTimeMD (CI)Certainty
RMDQ, PNE versus no PNE32.8 daysDM 2.28 (CI 0.30 to 4.25)Moderate
NRS, PNE versus no PNEShort termDM 0.73 (CI -0.14 to 1.61)Low
NRS, PNE versus no PNE12 monthsDM 0.44 (CI -1.03 to 1.91)Low
TSK, PNE versus no PNE3.3 weeksDM 4.72 (CI 2.32 to 7.13)Low. Labelled little or no effect, although the CI excludes 0.
RMDQ, PNE versus no PNE12 monthsDM 2.18 (CI -0.67 to 5.02)Low
RMDQ, PNE plus physiotherapy40 daysDM 3.94 (CI 3.37 to 4.52)Moderate
NRS, PNE plus physiotherapy32.6 daysDM 1.32 (CI 1.08 to 1.56)Moderate
A label that does not match its interval. The TSK row (MD 4.72; CI 2.32 to 7.13) says there may be little or no effect, and the interval excludes 0. Read the row with that tension. This page does not correct the label.

Knowledge and practice

rNPQ

Alhowimel et al. (2021): 111 Saudi physiotherapists, mean 6.7 ± 2.2 out of 12. 90% scored 9 or less.

Practice

Alshehri et al. (2020), n = 304. Patient education is used by 82.0%, electrotherapy by 61.9%, and spinal mobilisation or manipulation by 57.8%. Biomedical and biopsychosocial orientations were relatively low. Clinicians with a stronger biopsychosocial orientation use CFT more. The source does not give the score for those orientations.

Patients

Asiri et al. (2026), n = 298. Each 10 points of TSK were associated with +1.17 points of pain. Kinesiophobia explained 11% to 12% of the variance in pain.

Reanalysis of an Indian trial

Alalawi (2026, Umm Al-Qura) published secondary analyses of the RCT by Sidiq et al. (2024), conducted in India. These are not data collected in Saudi Arabia. The wellbeing mediation is in How it works. The recovery trajectories, with χ²(2) = 36.25, p < 0.001 and Cramer's V 0.63, are these:

TrajectoryPhysiotherapy alone (n = 46)Physiotherapy plus education (n = 46)
Minimal recovery28 (61%)12 (26%)
Psychosocial-dominant recovery18 (39%)8 (17%)
Global recovery0 (0%)26 (57%)

No PNE randomised trial in patients conducted in Saudi Arabia was found.

The Arabic-speaking world, which is not Saudi Arabia

Muhsen and Sheeha (2026) randomised 120 physiotherapy students in Jordan, not in Saudi Arabia. One 70 minute class gave an NNT of 2.7 for knowledge and 3.6 for attitudes. At 6 months only knowledge was maintained. The abstract extraction adds the adjusted knowledge difference: 2.46 (CI 1.68 to 3.24) after the class and 1.20 (CI 0.25 to 2.15) at 6 months. Muhsen et al. (2025) describe 216 Jordanian students.

Najem et al. (2025) is an F1000 preprint on culturally adapted Arabic PNE in Lebanon, with 12 patients and 8 physiotherapists. Basalem et al. (2025), a scoping review of 38 studies: educational interventions are the most culturally adapted (9 studies, 33%) and only 6 (22%) used adaptation frameworks.

No Arabic validation of the rNPQ or the COPI-Adult turned up. Without them, the knowledge mechanism cannot be measured in Arabic-speaking patients. The TSK-AV-11, the Arabic PCS and the Arabic CSI do have data, in the table in Dose.

A study proposal, not evidence. A design to discuss: first, Arabic validation of the rNPQ and the COPI-Adult. Then a feasibility pilot RCT in Riyadh, randomised and with a blinded assessor, in adults with chronic low back pain at medium or high risk: adapted PNE (about 200 minutes in total, in a group, in Arabic) plus exercise, versus the same contact time of biomedical and ergonomic education plus the same exercise. Feasibility outcomes would be recruitment, adherence, retention and acceptability. Exploratory clinical outcomes would be the Arabic RMDQ, NRS, TSK-AV-11, Arabic PCS, Arabic CSI, rNPQ, COPI and follow-up at 3, 6 and 12 months, with a preplanned mediation in the style of Cashin et al. A feasibility pilot does not need a power calculation. No sample size is proposed here. An athlete arm remains an option, with no figures.
09 / DATA

The extraction is here and on Kaggle.

The Kaggle release is public. Dataset: PNE Trials Evidence Extraction (CC BY 4.0). Notebook: PNE Trials Open Data Review, which downloads the O'Keeffe file from Zenodo when it runs and does not redistribute it.

The same derived extraction is in this repository. It is published, cited figures in three CSV files. It is not individual patient data. It does not copy third-party text or figures. The licence for these tables is CC BY 4.0. The generator code is MIT.

23 rows

Trials

pne_trials_extraction.csv. 39 columns. One row per report. Population recorded in the file: 20 patients, 2 student samples and 1 athlete sample.

21 rows

Effects

pne_trial_effects_long.csv. 11 columns. Long format: one row per report, outcome and time point, when the abstract gave a number.

42 rows

Estimates

pne_meta_estimates.csv. 17 columns. Estimates from reviews and from table 22, copied for the charts.

Columns in the trial extraction

report_idtrial_idfirst_authoryeardoiopen_access_statustext_readpopulation_typecountryconditionsettingn_randomisedn_analyseddesign_contrastpne_formatpne_sessionspne_total_minutescomparator_typecomparator_descriptioncombined_with_exercisetests_pne_contentpain_measureddisability_measuredkinesiophobia_measuredcatastrophising_measuredfollowup_timepointsprimary_outcomeprimary_timepointprimary_effect_as_reportedprimary_ci_as_reportedprimary_p_as_reportedprimary_resultpain_effect_as_reporteddisability_effect_as_reportedkinesiophobia_effect_as_reportedcatastrophising_effect_as_reportedregistrationsource_locationextraction_notes

Columns in the long file

report_idoutcome_domaininstrumenttimepointmetricestimateci_lowci_highp_as_reportedsign_conventionsource_location

Columns in the estimates file

chart_refsourcedoicomparisonoutcometimepointscalemetricestimateci_lowci_highp_as_reportedk_studiesn_participantscertaintysign_conventionsource_location

The primary_result field, as stored in the file, is null_result in 13 rows, positive in 7, positive (borderline) in 1, no_between_group_test in 1 and not_reported in 1. That is a count of the file's own labels, not a meta-analysis. The file notes say that Larsen et al. (2024) test exercise added to PNE, that Adenis 2024 and Adenis 2026 are the same trial, that Maguire and Muhsen are students, that Ganapathy et al. (2026) has no abstract and nothing was extracted, and that Sousa et al. (2024) was added from the data search and is not part of the narrative in the other sections.

O'Keeffe and Zenodo record 6760585. The cognitive functional therapy trial dataset (O'Keeffe et al.) is at https://doi.org/10.5281/zenodo.6760585 (record 6760585), CC BY 4.0, published on 27 June 2022. It has 206 rows and 145 columns: 106 in one arm and 100 in the other, in line with CFT (n = 106) versus group exercise and education (n = 100). It is not pure PNE: CFT includes reconceptualisation inside a cognitive functional approach, and the comparator also included education. This repository does not redistribute that file. The only link is the Zenodo record.

Other open data, linked only

  • Dehghani et al. (2026), PNE plus Flexi-Bar exercise, PLOS ONE. Article 10.1371/journal.pone.0355692. Supplement S1, CC BY 4.0, n = 48: 10.1371/journal.pone.0355692.s001. The extraction note says the means in table 2 of the article do not match the supplement CSV. This site does not redistribute that CSV.
  • Windsor, adapted PNE, Figshare, CC BY 4.0, n = 21 (13 adapted PNE and 8 general health education). Four 15 minute sessions, one a month, individual. It is not randomised and the record does not link a verified article. 10.6084/m9.figshare.26018443 and 10.6084/m9.figshare.26018440.
  • Understanding of Pain, Figshare, CC BY 4.0, n = 55 third-year students, not patients. NPQ and HC-PAIRS. 10.6084/m9.figshare.5913511.

The search on 30 October 2026 found no pain neuroscience education dataset on Kaggle. Malfliet et al. (2025) state that the data are not available. The data statements for Larsen et al. (2024), RESOLVE, RESTORE, PREVENT and Chimenti et al. (2023) were left unverified in that search.

10 / SOURCES

References and link status.

91 sources in APA 7. Titles are copied as Crossref records them, so some keep title case. The year is the print year when one exists.

Status recorded in the check of 30 October 2026: 11 with the full text read, 57 open with the abstract read, and 23 abstract only. Each DOI in this list resolved at doi.org with a 302 response. The three guidelines without a DOI returned 200. The filter below needs JavaScript. Without it, the full list is visible.

91 sources shown

  1. Aldera, M., Alturkistany, A., Al Rayes, H., Rada, G., Alsulaimany, H. H., Alsobayel, H. I., Alghamdi, K., Awwad, W., Alyamani, O. A., Bedaiwi, M., Alqahtani, Y., Almaghlouth, I., Bahlas, S. M., Alazmi, M. S., Brunnhuber, K., Alhelal, F., & Alshehri, M. A. (2026). Saudi Clinical Practice Guideline for the Assessment and Management of Low Back Pain and Sciatica in Adults. Journal of Clinical Medicine, 15(2), 528. https://doi.org/10.3390/jcm15020528 Open, full text read DOI: resolved (302) on 30 October 2026
  2. George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S. (2021). Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1-CPG60. https://doi.org/10.2519/jospt.2021.0304 Open, full text read DOI: resolved (302) on 30 October 2026
  3. Apeldoorn, A. T., Swart, N. M., Conijn, D., Meerhoff, G. A., & Ostelo, R. W. (2024). Management of low back pain and lumbosacral radicular syndrome: the Guideline of the Royal Dutch Society for Physical Therapy (KNGF). European Journal of Physical and Rehabilitation Medicine, 60(2). https://doi.org/10.23736/s1973-9087.24.08352-7 Open, abstract read DOI: resolved (302) on 30 October 2026
  4. Moseley, G. L., & Butler, D. S. (2015). Fifteen Years of Explaining Pain: The Past, Present, and Future. The Journal of Pain, 16(9), 807-813. https://doi.org/10.1016/j.jpain.2015.05.005 Open, abstract read DOI: resolved (302) on 30 October 2026
  5. Moseley, G. L., Nicholas, M. K., & Hodges, P. W. (2004). A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain. The Clinical Journal of Pain, 20(5), 324-330. https://doi.org/10.1097/00002508-200409000-00007 Abstract only DOI: resolved (302) on 30 October 2026
  6. Moseley, G. (2004). Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. European Journal of Pain, 8(1), 39-45. https://doi.org/10.1016/s1090-3801(03)00063-6 Abstract only DOI: resolved (302) on 30 October 2026
  7. Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain. Archives of Physical Medicine and Rehabilitation, 92(12), 2041-2056. https://doi.org/10.1016/j.apmr.2011.07.198 Abstract only DOI: resolved (302) on 30 October 2026
  8. Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 32(5), 332-355. https://doi.org/10.1080/09593985.2016.1194646 Abstract only DOI: resolved (302) on 30 October 2026
  9. Louw, A., Sluka, K. A., Nijs, J., Courtney, C. A., & Zimney, K. (2021). Revisiting the Provision of Pain Neuroscience Education: An Adjunct Intervention for Patients but a Primary Focus of Clinician Education. Journal of Orthopaedic & Sports Physical Therapy, 51(2), 57-59. https://doi.org/10.2519/jospt.2021.9804 Abstract only DOI: resolved (302) on 30 October 2026
  10. Louw, A., Puentedura, E. J., Diener, I., Zimney, K. J., & Cox, T. (2019). Pain neuroscience education: Which pain neuroscience education metaphor worked best? South African Journal of Physiotherapy, 75(1). https://doi.org/10.4102/sajp.v75i1.1329 Open, abstract read DOI: resolved (302) on 30 October 2026
  11. Nijs, J., Wijma, A. J., Willaert, W., Huysmans, E., Mintken, P., Smeets, R., Goossens, M., van Wilgen, C. P., Van Bogaert, W., Louw, A., Cleland, J., & Donaldson, M. (2020). Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians. Physical Therapy, 100(5), 846-859. https://doi.org/10.1093/ptj/pzaa021 Open, abstract read DOI: resolved (302) on 30 October 2026
  12. O'Sullivan, P. B., Caneiro, J. P., O'Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O'Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408-423. https://doi.org/10.1093/ptj/pzy022 Open, abstract read DOI: resolved (302) on 30 October 2026
  13. Kent, P., Haines, T., O'Sullivan, P., Smith, A., Campbell, A., Schutze, R., Attwell, S., Caneiro, J. P., Laird, R., O'Sullivan, K., McGregor, A., Hartvigsen, J., Lee, D.-C. A., Vickery, A., & Hancock, M. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet, 401(10391), 1866-1877. https://doi.org/10.1016/s0140-6736(23)00441-5 Open, abstract read DOI: resolved (302) on 30 October 2026
  14. Thiveos, L., Kent, P., Pocovi, N. C., O'Sullivan, P., & Hancock, M. J. (2024). Cognitive Functional Therapy for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Physical Therapy, 104(12), pzae128. https://doi.org/10.1093/ptj/pzae128 Open, abstract read DOI: resolved (302) on 30 October 2026
  15. Catley, M. J., O'Connell, N. E., & Moseley, G. L. (2013). How Good Is the Neurophysiology of Pain Questionnaire? A Rasch Analysis of Psychometric Properties. The Journal of Pain, 14(8), 818-827. https://doi.org/10.1016/j.jpain.2013.02.008 Open, abstract read DOI: resolved (302) on 30 October 2026
  16. Pate, J. W., Simons, L. E., Rush, G., Hancock, M. J., Hush, J. M., Verhagen, A., & Pacey, V. (2022). The Concept of Pain Inventory for Adults (COPI-Adult). The Clinical Journal of Pain, 38(1), 32-40. https://doi.org/10.1097/ajp.0000000000000990 Open, abstract read DOI: resolved (302) on 30 October 2026
  17. Terkawi, A., Sullivan, M., Abolkhair, A., Al-Zhahrani, T., Terkawi, R., Alasfar, E., Khait, S. A., Elkabbani, A., Kabbani, N., Altirkawi, K., & Tsang, S. (2017). Development and validation of Arabic version of the pain catastrophizing scale. Saudi Journal of Anaesthesia, 11(5), 63. https://doi.org/10.4103/sja.sja_130_17 Open, abstract read DOI: resolved (302) on 30 October 2026
  18. AL-Shudifat, A., Farah, K., Hawamdeh, Z. M., Alqudah, A., & Juweid, M. E. (2020). Psychometric testing of a short form, 11-item Tampa Scale of Kinesiophobia-Arabic version. Medicine, 99(24), e20292. https://doi.org/10.1097/md.0000000000020292 Open, abstract read DOI: resolved (302) on 30 October 2026
  19. Tamboosi, S. E., Alzahrani, H., Alshehri, F. H., Alzhrani, M., & S. Alshehri, Y. (2024). Cross-cultural adaptation and psychometric properties of the Arabic version of the Central Sensitization Inventory in people with chronic musculoskeletal pain. PeerJ, 12, e18251. https://doi.org/10.7717/peerj.18251 Open, abstract read DOI: resolved (302) on 30 October 2026
  20. Madi, M., Hamzeh, H., Abujaber, S., & Altubasi, I. (2022). Cross cultural adaptation, validity, and reliability of Central Sensitization Inventory in Arabic language. Disability and Rehabilitation, 44(25), 8075-8083. https://doi.org/10.1080/09638288.2021.2006322 Open, abstract read DOI: resolved (302) on 30 October 2026
  21. Bagg, M. K., Wand, B. M., Cashin, A. G., Lee, H., Hübscher, M., Stanton, T. R., O'Connell, N. E., O'Hagan, E. T., Rizzo, R. R. N., Wewege, M. A., Rabey, M., Goodall, S., Saing, S., Lo, S. N., Luomajoki, H., Herbert, R. D., Maher, C. G., Moseley, G. L., & McAuley, J. H. (2022). Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain. JAMA, 328(5), 430. https://doi.org/10.1001/jama.2022.9930 Open, abstract read DOI: resolved (302) on 30 October 2026
  22. Cashin, A. G., Lee, H., Wand, B. M., Bagg, M. K., O'Hagan, E. T., Rizzo, R. R., Stanton, T. R., Moseley, G. L., & McAuley, J. H. (2023). Mechanisms of education and graded sensorimotor retraining in people with chronic low back pain: a mediation analysis. Pain, 164(12), 2792-2800. https://doi.org/10.1097/j.pain.0000000000002978 Abstract only DOI: resolved (302) on 30 October 2026
  23. Traeger, A. C., Lee, H., Hübscher, M., Skinner, I. W., Moseley, G. L., Nicholas, M. K., Henschke, N., Refshauge, K. M., Blyth, F. M., Main, C. J., Hush, J. M., Lo, S., & McAuley, J. H. (2019). Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain. JAMA Neurology, 76(2), 161. https://doi.org/10.1001/jamaneurol.2018.3376 Open, abstract read DOI: resolved (302) on 30 October 2026
  24. Cashin, A. G., Lee, H., Traeger, A. C., Moseley, G. L., Hübscher, M., Kamper, S. J., Skinner, I. W., & McAuley, J. H. (2022). Producing Clinically Meaningful Reductions in Disability: A Causal Mediation Analysis of a Patient Education Intervention. The Journal of Pain, 23(2), 236-247. https://doi.org/10.1016/j.jpain.2021.07.007 Open, abstract read DOI: resolved (302) on 30 October 2026
  25. Murillo, C., Galán-Martín, M. Á., Montero-Cuadrado, F., Lluch, E., Meeus, M., & Loh, W. W. (2023). Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care. Pain, 164(10), 2296-2305. https://doi.org/10.1097/j.pain.0000000000002929 Open, abstract read DOI: resolved (302) on 30 October 2026
  26. Ashar, Y. K., Gordon, A., Schubiner, H., Uipi, C., Knight, K., Anderson, Z., Carlisle, J., Polisky, L., Geuter, S., Flood, T. F., Kragel, P. A., Dimidjian, S., Lumley, M. A., & Wager, T. D. (2022). Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry, 79(1), 13. https://doi.org/10.1001/jamapsychiatry.2021.2669 Open, abstract read DOI: resolved (302) on 30 October 2026
  27. Venter, M., McAuley, J. H., Hansford, H. J., Ryan, M., Bagg, M. K., Wand, B. M., & Cashin, A. G. (2026). Effect Modifiers of Graded Sensorimotor Retraining for Chronic Low Back Pain. JAMA Network Open, 9(1), e2552787. https://doi.org/10.1001/jamanetworkopen.2025.52787 Open, abstract read DOI: resolved (302) on 30 October 2026
  28. Rizzo, R. R. N., Wand, B. M., Leake, H. B., O'Hagan, E. T., Traeger, A. C., Gustin, S. M., Moseley, G. L., Sharma, S., Cashin, A. G., Bagg, M. K., McAuley, J. H., & Bunzli, S. (2024). Why might fears and worries persist after a pain education-grounded multimodal intervention for chronic back pain? A qualitative study. PAIN Reports, 9(6), e1197. https://doi.org/10.1097/pr9.0000000000001197 Open, abstract read DOI: resolved (302) on 30 October 2026
  29. Ram, A., Booth, J., Thom, J. M., Gibbs, M. T., & Jones, M. D. (2023). Are Improvements in Pain Neurophysiology Knowledge Following Pain Science Education Associated With Improved Outcomes in People With Chronic Pain? The Clinical Journal of Pain, 39(1), 41-52. https://doi.org/10.1097/ajp.0000000000001086 Open, abstract read DOI: resolved (302) on 30 October 2026
  30. Núñez-Cortés, R., Salazar-Méndez, J., Calatayud, J., Lluch, E., López-Bueno, R., Horment-Lara, G., Cruz-Montecinos, C., & Suso-Martí, L. (2024). How do the target concepts of pain science education combined with exercise contribute to the effect on pain intensity and disability in patients with chronic spinal pain? A systematic review and meta-analysis with moderator analysis. Neuroscience & Biobehavioral Reviews, 163, 105740. https://doi.org/10.1016/j.neubiorev.2024.105740 Abstract only DOI: resolved (302) on 30 October 2026
  31. Núñez-Cortés, R., Salazar-Méndez, J., Calatayud, J., Malfliet, A., Lluch, E., Mendez-Rebolledo, G., Guzmán-Muñoz, E., López-Bueno, R., & Suso-Martí, L. (2024). The optimal dose of pain neuroscience education added to an exercise programme for patients with chronic spinal pain: a systematic review and dose-response meta-analysis. Pain, 165(6), 1196-1206. https://doi.org/10.1097/j.pain.0000000000003126 Abstract only DOI: resolved (302) on 30 October 2026
  32. Salazar-Méndez, J., Núñez-Cortés, R., Suso-Martí, L., Ribeiro, I. L., Garrido-Castillo, M., Gacitúa, J., Mendez-Rebolledo, G., Cruz-Montecinos, C., López-Bueno, R., & Calatayud, J. (2023). Dosage matters: Uncovering the optimal duration of pain neuroscience education to improve psychosocial variables in chronic musculoskeletal pain. A systematic review and meta-analysis with moderator analysis. Neuroscience & Biobehavioral Reviews, 153, 105328. https://doi.org/10.1016/j.neubiorev.2023.105328 Abstract only DOI: resolved (302) on 30 October 2026
  33. Romm, M. J., Ahn, S., Fiebert, I., & Cahalin, L. P. (2021). A Meta-Analysis of Therapeutic Pain Neuroscience Education, Using Dosage and Treatment Format as Moderator Variables. Pain Practice, 21(3), 366-380. https://doi.org/10.1111/papr.12962 Abstract only DOI: resolved (302) on 30 October 2026
  34. Salazar-Méndez, J., Cuyul-Vásquez, I., Ponce-Fuentes, F., Núñez-Cortés, R., Mendez-Rebolledo, G., & Fuentes, J. (2024). Effectiveness of in-group versus individually administered pain neuroscience education on clinical and psychosocial outcomes in patients with chronic low back pain: randomized controlled study protocol. PeerJ, 12, e17507. https://doi.org/10.7717/peerj.17507 Open, abstract read DOI: resolved (302) on 30 October 2026
  35. de Oliveira Lima, L., Saragiotto, B. T., Costa, L. O. P., Nogueira, L. C., Meziat-Filho, N., & Reis, F. J. J. (2021). Self-Guided Web-Based Pain Education for People With Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Physical Therapy, 101(10), pzab167. https://doi.org/10.1093/ptj/pzab167 Abstract only DOI: resolved (302) on 30 October 2026
  36. Tomás-Rodríguez, M. I., Asensio-García, M. D. R., García, R. N., Delicado-Miralles, M., Sánchez, S. H., & Segura-Heras, J. V. (2024). Short- and medium-term effects of a single session of pain neuroscience education on pain and psychological factors in patients with chronic low back pain. A single-blind randomized clinical trial. European Journal of Pain, 28(10), 1841-1854. https://doi.org/10.1002/ejp.4700 Open, abstract read DOI: resolved (302) on 30 October 2026
  37. McConnell, R., Lane, E., Webb, G., LaPeze, D., Grillo, H., & Fritz, J. (2024). A multicenter feasibility randomized controlled trial using a virtual reality application of pain neuroscience education for adults with chronic low back pain. Annals of Medicine, 56(1), 2311846. https://doi.org/10.1080/07853890.2024.2311846 Open, abstract read DOI: resolved (302) on 30 October 2026
  38. Kühn, L., Wengemuth, E., Kleist, L., & Choi, K. E. (. (2026). Acceptance of pain neuroscience education in chronic musculoskeletal pain conditions: qualitative systematic review. PAIN Reports, 11(2). https://doi.org/10.1097/pr9.0000000000001420 Open, abstract read DOI: resolved (302) on 30 October 2026
  39. Ciolan, F., Bertoni, G., Crestani, M., Falsiroli Maistrello, L., Coppola, I., Rossettini, G., & Battista, S. (2025). Perceived factors influencing the success of pain neuroscience education in chronic musculoskeletal pain: a meta-synthesis of qualitative studies. Disability and Rehabilitation, 47(10), 2459-2474. https://doi.org/10.1080/09638288.2024.2398141 Open, abstract read DOI: resolved (302) on 30 October 2026
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  44. Bonatesta, L., Ruiz-Cárdenas, J. D., Fernández-Azorín, L., & Rodríguez-Juan, J. J. (2022). Pain Science Education Plus Exercise Therapy in Chronic Nonspecific Spinal Pain: A Systematic Review and Meta-analyses of Randomized Clinical Trials. The Journal of Pain, 23(4), 535-546. https://doi.org/10.1016/j.jpain.2021.09.006 Open, abstract read DOI: resolved (302) on 30 October 2026
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  47. Suso-Martí, L., Cuenca-Martínez, F., Alba-Quesada, P., Muñoz-Alarcos, V., Herranz-Gómez, A., Varangot-Reille, C., Domínguez-Navarro, F., & Casaña, J. (2022). Effectiveness of Pain Neuroscience Education in Patients with Fibromyalgia: A Systematic Review and Meta-Analysis. Pain Medicine, 23(11), 1837-1850. https://doi.org/10.1093/pm/pnac077 Abstract only DOI: resolved (302) on 30 October 2026
  48. Cuenca-Martínez, F., Suso-Martí, L., Calatayud, J., Ferrer-Sargues, F. J., Muñoz-Alarcos, V., Alba-Quesada, P., & Biviá-Roig, G. (2023). Pain neuroscience education in patients with chronic musculoskeletal pain: an umbrella review. Frontiers in Neuroscience, 17, 1272068. https://doi.org/10.3389/fnins.2023.1272068 Open, abstract read DOI: resolved (302) on 30 October 2026
  49. Watson, J. A., Ryan, C. G., Atkinson, G., Williamson, P., Ellington, D., Whittle, R., Dixon, J., & Martin, D. J. (2021). Inter-Individual Differences in the Responses to Pain Neuroscience Education in Adults With Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Journal of Pain, 22(1), 9-20. https://doi.org/10.1016/j.jpain.2020.03.006 Open, abstract read DOI: resolved (302) on 30 October 2026
  50. Escriche-Escuder, A., Nijs, J., Silbernagel, K. G., van Wilgen, C. P., Plinsinga, M. L., Casaña, J., & Cuesta-Vargas, A. I. (2023). Pain neuroscience education in persistent painful tendinopathies: A scoping review from the Tendon PNE Network. Physical Therapy in Sport, 63, 38-49. https://doi.org/10.1016/j.ptsp.2023.07.002 Open, abstract read DOI: resolved (302) on 30 October 2026
  51. Ma, X., Chen, R., Li, W., & Huang, P. (2024). A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-term outcomes of pain and disability. Physiotherapy Theory and Practice, 40(9), 2130-2149. https://doi.org/10.1080/09593985.2023.2232003 Abstract only DOI: resolved (302) on 30 October 2026
  52. Lin, L., Lin, T., Chang, K., Wu, W., & Özçakar, L. (2024). Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials. European Journal of Pain, 28(2), 231-243. https://doi.org/10.1002/ejp.2182 Abstract only DOI: resolved (302) on 30 October 2026
  53. Lesmond, I., Calvache-Mateo, A., Heredia-Ciuró, A., Martín-Núñez, J., Navas-Otero, A., López-López, L., & Valenza, M. C. (2024). Neurophysiological pain education for patients with symptomatic knee osteoarthritis: A systematic review and meta-analysis. Patient Education and Counseling, 120, 108128. https://doi.org/10.1016/j.pec.2023.108128 Open, abstract read DOI: resolved (302) on 30 October 2026
  54. Salazar-Méndez, J., Gajardo, K. G., Muñoz-Tapia, M. F., Sepúlveda-Urrutia, C., Viscay-Sanhueza, N., & Mendez-Rebolledo, G. (2024). Efficacy of preoperative pain neuroscience education in physical therapy on clinical outcomes in patients undergoing arthroplasty: A systematic review of randomized clinical trials. Journal of Bodywork and Movement Therapies, 40, 109-116. https://doi.org/10.1016/j.jbmt.2024.04.007 Abstract only DOI: resolved (302) on 30 October 2026
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  57. Tatikola, S. P., Natarajan, V., Amaravadi, S. K., Desai, V. K., Asirvatham, A. R., & Nagaraja, R. (2025). Effect of pain neuroscience education+ (PNE+) in people with different mechanisms of chronic pain: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies, 41, 215-237. https://doi.org/10.1016/j.jbmt.2024.11.016 Abstract only DOI: resolved (302) on 30 October 2026
  58. Medina-Viedma, L., Cortés-Pérez, I., Obrero-Gaitán, E., Osuna-Pérez, M. C., Díaz-Fernández, Á., López-Ruiz, M. d. C., & Zagalaz-Anula, N. (2025). Effectiveness of Pain Neuroscience Education in Reducing Pain, Disability, Kinesiophobia, and Catastrophizing in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Medical Sciences, 13(4), 290. https://doi.org/10.3390/medsci13040290 Open, abstract read DOI: resolved (302) on 30 October 2026
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  63. Chimenti, R. L., Post, A. A., Rio, E. K., Moseley, G. L., Dao, M., Mosby, H., Hall, M., de Cesar Netto, C., Wilken, J. M., Danielson, J., Bayman, E. O., & Sluka, K. A. (2023). The effects of pain science education plus exercise on pain and function in chronic Achilles tendinopathy: a blinded, placebo-controlled, explanatory, randomized trial. Pain, 164(1), e47-e65. https://doi.org/10.1097/j.pain.0000000000002720 Open, abstract read DOI: resolved (302) on 30 October 2026
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