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Back and Neck Pain - How can education change pain ?

Updated: Jun 25


Pain neuroscience education (PNE) is education focused on the neurobiology and physiology of pain.

This assists patients to reconceptualise the way they perceive pain, moving away from a view that pain indicates tissue damage (Louw, Diener, Butler, & Puentedura, 2011) to a biopsychosocial understanding of pain (King et al., 2018).

Education is strongly recommended for treatment with chronic lower back pain and neck pain (Oliveira et al., 2018).

Can you change my pain even if you don't touch me?

The science says education about pain can;

  • empower patients to actively problem solve pain flair ups(Louw et al., 2011).

  • help patients increase activity tolerance (Marris, Theophanous, & Donaldson, 2019),

  • enables the patient to fully understand how their thoughts , beliefs, behaviour and environment may influence and perpetuate their pain experience (Adams & Turk, 2018).

  • improve confidence managing pain (Silva Guerrero et al., 2018).

PNE in patients with back pain have been shown to reduce:

  • how bad it feels and how dangerous, at long term followup

  • reducing depression in the short term(Silva Guerrero et al., 2018).

  • in conjunction with exercise, pain education can improve patient’s pain and disability in short term follow up in chronic lower back pain (CLBP) (Wood & Hendrick, 2019).

Move Quotes


Adams, V. J., Walker, B., Jepson, D., Cooper, C., Tyler, J., Clewley, D., . . . Nitsch, K. P. (2017). Measurement characteristics and clinical utility of the Pain Catastrophizing Scale in individuals experiencing low back pain. Archives of Physical Medicine and Rehabilitation, 98(11), 2350-2351.

Almeida, M., Saragiotto, B., Richards, B., & Maher, C. G. (2018). Primary care management of non‐specific low back pain: key messages from recent clinical guidelines. Medical Journal of Australia, 208(6), 272-275.

Anderson, T. M., Sunderland, M., Andrews, G., Titov, N., Dear, B. F., & Sachdev, P. S. (2013). The 10-item Kessler psychological distress scale (K10) as a screening instrument in older individuals. The American journal of geriatric psychiatry, 21(7), 596-606.

Andrews, G., & Slade, T. (2001). Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health, 25(6), 494-497. doi:10.1111/j.1467-842x.2001.tb00310.x

Australian Institute of Health and Welfare. (2019) Back problems. Retrieved from Canberra: AIHW

Australian Institute of Health and Welfare. (2020). Chronic pain in Australia. Canberra: AIHW. Retrieved from Canberra:

Bair, M. J., Robinson, R. L., Katon, W., & Kroenke, K. (2003). Depression and pain comorbidity: a literature review. Arch Intern Med, 163(20), 2433-2445. doi:10.1001/archinte.163.20.2433

Bair, M. J., Wu, J., Damush, T. M., Sutherland, J. M., & Kroenke, K. (2008). Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med, 70(8), 890-897. doi:10.1097/PSY.0b013e318185c510

Bardin, L. D., King, P., & Maher, C. G. (2017). Diagnostic triage for low back pain: a practical approach for primary care. Med J Aust, 206(6), 268-273. doi:10.5694/mja16.00828

Benaim, C., Blaser, S., Léger, B., Vuistiner, P., & Luthi, F. (2019). “Minimal clinically important difference” estimates of 6 commonly-used performance tests in patients with chronic musculoskeletal pain completing a work-related multidisciplinary rehabilitation program. BMC Musculoskeletal Disorders, 20(1), 16. doi:10.1186/s12891-018-2382-2

Bennell, K., Dobson, F., & Hinman, R. (2011). Measures of physical performance assessments: Self‐Paced Walk Test (SPWT), Stair Climb Test (SCT), Six‐Minute Walk Test (6MWT), Chair Stand Test (CST), Timed Up & Go (TUG), Sock Test, Lift and Carry Test (LCT), and Car Task. Arthritis care & research, 63(S11), S350-S370.

Bernstein, I. A., Malik, Q., Carville, S., & Ward, S. (2017). Low back pain and sciatica: summary of NICE guidance. Bmj, 356.

Bohannon, R. W., & Crouch, R. (2017). Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. Journal of Evaluation in Clinical Practice, 23(2), 377-381. doi:10.1111/jep.12629

Brunner, E., Dankaerts, W., Meichtry, A., O’Sullivan, K., & Probst, M. (2018). Physical Therapists’ Ability to Identify Psychological Factors and Their Self-Reported Competence to Manage Chronic Low Back Pain. Physical Therapy, 98(6), 471-479. doi:10.1093/ptj/pzy012

Chan, S. M., & Fung, T. C. T. (2014). Reliability and validity of K10 and K6 in screening depressive symptoms in Hong Kong adolescents. Vulnerable Children and Youth Studies, 9(1), 75-85. doi:10.1080/17450128.2013.861620

Chiarotto, A., Boers, M., Deyo, R. A., Buchbinder, R., Corbin, T. P., Costa, L. O. P., . . . Ostelo, R. W. (2018). Core outcome measurement instruments for clinical trials in nonspecific low back pain. Pain, 159(3), 481-495. doi:10.1097/j.pain.0000000000001117

Cornelius, B. L., Groothoff, J. W., van der Klink, J. J., & Brouwer, S. (2013). The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants. BMC Public Health, 13, 128. doi:10.1186/1471-2458-13-128

Fehrmann, E., Kotulla, S., Fischer, L., Kienbacher, T., Tuechler, K., Mair, P., . . . Paul, B. (2019). The impact of age and gender on the ICF-based assessment of chronic low back pain. Disability and Rehabilitation, 41(10), 1190-1199. doi:10.1080/09638288.2018.1424950

Fernandes, L., Storheim, K., Lochting, I., & Grotle, M. (2012). Cross-cultural adaptation and validation of the Norwegian pain catastrophizing scale in patients with low back pain. BMC Musculoskelet Disord, 13, 111. doi:10.1186/1471-2474-13-111

Fréz, A. R., Binda, A. C., Dubiela, A., Daniel, C. R., Bertolini, G. R. F., Ruaro, J. A., . . . Baroni, M. P. (2016). Functional profile of active older adults with low back pain, accoding to the ICF. Revista Brasileira de Medicina do Esporte, 22, 252-255. Retrieved from

George, S. Z., Valencia, C., & Beneciuk, J. M. (2010). A psychometric investigation of fear-avoidance model measures in patients with chronic low back pain. Journal of Orthopaedic & Sports Physical Therapy, 40(4), 197-205.

Gill, J. R., & Brown, C. A. (2009). A structured review of the evidence for pacing as a chronic pain intervention. European Journal of Pain, 13(2), 214-216. doi:10.1016/j.ejpain.2008.03.011

Goossens, M. E., de Kinderen, R. J., Leeuw, M., de Jong, J. R., Ruijgrok, J., Evers, S. M., & Vlaeyen, J. W. (2015). Is exposure in vivo cost-effective for chronic low back pain? A trial-based economic evaluation. BMC health services research, 15(1), 549.

Henry, J. D., & Crawford, J. R. (2005). The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample. British journal of clinical psychology, 44(2), 227-239.

Hernandes, N. A., Wouters, E. F., Meijer, K., Annegarn, J., Pitta, F., & Spruit, M. A. (2011). Reproducibility of 6-minute walking test in patients with COPD. Eur Respir J, 38(2), 261-267. doi:10.1183/09031936.00142010

Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J., Ostelo, R., Guzman, J., & van Tulder, M. W. (2014). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database of Systematic Reviews(9). doi:10.1002/14651858.CD000963.pub3

Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J. F., Gfroerer, J. C., Hiripi, E., . . . Walters, E. E. (2003). Screening for serious mental illness in the general population. Archives of general psychiatry, 60(2), 184-189.

King, R., Robinson, V., Elliott-Button, H. L., Watson, J. A., Ryan, C. G., & Martin, D. J. (2018). Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study. Pain Research and Management, 2018, 3745651. doi:10.1155/2018/3745651

Kostanjsek, N., Rubinelli, S., Escorpizo, R., Cieza, A., Kennedy, C., Selb, M., . . . Üstün, T. B. (2011). Assessing the impact of health conditions using the ICF. Disability and Rehabilitation, 33(15-16), 1475-1482. doi:10.3109/09638288.2010.527032

Leung, L. (2012). Pain catastrophizing: an updated review. Indian journal of psychological medicine, 34(3), 204-217. doi:10.4103/0253-7176.106012

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., . . . O’Sullivan, P. P. B. (2020). What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. British Journal of Sports Medicine, 54(2), 79. doi:10.1136/bjsports-2018-099878

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. doi:

Louw, A., Goldrick, S., Bernstetter, A., Van Gelder, L. H., Parr, A., Zimney, K., & Cox, T. (2020). Evaluation is treatment for low back pain. Journal of Manual & Manipulative Therapy, 1-10. doi:10.1080/10669817.2020.1730056

Louw, A., Zimney, K., O’Hotto, C., & Hilton, S. (2016). The clinical application of teaching people about pain. Physiotherapy Theory and Practice, 32(5), 385-395. doi:10.1080/09593985.2016.1194652

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.

Maher, C., Underwood, M., & Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.

Marris, D., Theophanous, K., Cabezon, P., Dunlap, Z., & Donaldson, M. (2019). The impact of combining pain education strategies with physical therapy interventions for patients with chronic pain: a systematic review and meta-analysis of randomized controlled trials. Physiotherapy Theory and Practice, 1-12.

Meucci, R. D., Fassa, A. G., & Faria, N. M. (2015). Prevalence of chronic low back pain: systematic review. Rev Saude Publica, 49, 1. doi:10.1590/s0034-8910.2015049005874

Morin Chabane, S., Coutinho, F., Laliberte, M., & Feldman, D. (2020). Outpatient physiotherapists’ attitudes and beliefs toward patients with chronic pain: A qualitative study. Physiotherapy Theory and Practice, 36(1), 85-94. doi:10.1080/09593985.2018.1481161

Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., . . . The, I. T. f. t. C. o. C. P. (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain, 160(1). Retrieved from

Nicholas, M. K., Costa, D. S. J., Blanchard, M., Tardif, H., Asghari, A., & Blyth, F. M. (2019). Normative data for common pain measures in chronic pain clinic populations: closing a gap for clinicians and researchers. Pain, 160(5), 1156-1165. doi:10.1097/j.pain.0000000000001496

Nijs, J., Meeus, M., Cagnie, B., Roussel, N. A., Dolphens, M., Van Oosterwijck, J., & Danneels, L. (2014). A modern neuroscience approach to chronic spinal pain: combining pain neuroscience education with cognition-targeted motor control training. Phys Ther, 94(5), 730-738. doi:10.2522/ptj.20130258

Nugraha, B., Gutenbrunner, C., Barke, A., Karst, M., Schiller, J., Schäfer, P., . . . The, I. T. f. t. C. o. C. P. (2019). The IASP classification of chronic pain for ICD-11: functioning properties of chronic pain. Pain, 160(1). Retrieved from

O'Connell, N. E., Cook, C. E., Wand, B. M., & Ward, S. P. (2016). Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines. Best Practice & Research Clinical Rheumatology, 30(6), 968-980. doi:

Oliveira, C. B., Maher, C. G., Pinto, R. Z., Traeger, A. C., Lin, C.-W. C., Chenot, J.-F., . . . Koes, B. W. (2018). Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal, 27(11), 2791-2803.

Peppin, J. F., Marcum, S., & Kirsh, K. L. (2014). The chronic pain patient and functional assessment: use of the 6-Minute Walk Test in a multidisciplinary pain clinic. Current Medical Research and Opinion, 30(3), 361-365. doi:10.1185/03007995.2013.828587

Perini, S. J., Slade, T., & Andrews, G. (2006). Generic effectiveness measures: sensitivity to symptom change in anxiety disorders. J Affect Disord, 90(2-3), 123-130. doi:10.1016/j.jad.2005.10.011

Pires, D. A. d. F., Brazete Cruz, E. J. C., Canhão, H. C. d. M., & Nunes, C. d. R. D. (2020). The role of pain and disability changes after physiotherapy treatment on global perception of improvement in patients with chronic low back pain. Musculoskeletal Science and Practice, 47, 102139. doi:

Postma, S. A. E., van Boven, K., Ten Napel, H., Gerritsen, D. L., Assendelft, W. J. J., Schers, H., & Olde Hartman, T. C. (2018). The development of an ICF-based questionnaire for patients with chronic conditions in primary care. Journal of Clinical Epidemiology, 103, 92-100. doi:10.1016/j.jclinepi.2018.07.005

Rice, A. S., Smith, B. H., & Blyth, F. M. (2016). Pain and the global burden of disease. Pain, 157(4), 791-796.

Sathya, P., Ramakrishnan, K., & Shah, P. P. (2015). Prevalence of depression, anxiety & stress in patients with mechanical low back pain. International Journal of Therapies and Rehabilitation Research, 4(4), 67-72.

Schreijenberg, M., Koes, B. W., & Lin, C.-W. C. (2019). Guideline recommendations on the pharmacological management of non-specific low back pain in primary care – is there a need to change? Expert Review of Clinical Pharmacology, 12(2), 145-157. doi:10.1080/17512433.2019.1565992

Silva Guerrero, A. V., Maujean, A., Campbell, L., & Sterling, M. (2018). A Systematic Review and Meta-Analysis of the Effectiveness of Psychological Interventions Delivered by Physiotherapists on Pain, Disability and Psychological Outcomes in Musculoskeletal Pain Conditions. Clin J Pain, 34(9), 838-857. doi:10.1097/ajp.0000000000000601

Smith, B. H., Fors, E. A., Korwisi, B., Barke, A., Cameron, P., Colvin, L., . . . Treede, R.-D. (2019). The IASP classification of chronic pain for ICD-11: applicability in primary care. Pain, 160(1), 83-87.

Smith, T. O., Dainty, J. R., Williamson, E., & Martin, K. R. (2018). Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing. British Journal of Pain, 13(2), 82-90. doi:10.1177/2049463718802868

Stier-Jarmer, M., Cieza, A., Borchers, M., & Stucki, G. (2009). How to Apply the ICF and ICF Core Sets for Low Back Pain. The Clinical Journal of Pain, 25(1). Retrieved from

Sullivan, M. J., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: development and validation. Psychological assessment, 7(4), 524.

Treede, R.-D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., . . . First, M. B. (2019). Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain, 160(1), 19-27.

Turk, D. C., & Dworkin, R. H. (2004). What should be the core outcomes in chronic pain clinical trials? Arthritis Res Ther, 6(4), 151. doi:10.1186/ar1196

Van Erp, R. M. A., Huijnen, I. P. J., Jakobs, M. L. G., Kleijnen, J., & Smeets, R. J. E. M. (2019). Effectiveness of Primary Care Interventions Using a Biopsychosocial Approach in Chronic Low Back Pain: A Systematic Review. Pain Practice, 19(2), 224-241. doi:10.1111/papr.12735

Van Oosterwijck, J., Nijs, J., Meeus, M., Truijen, S., Craps, J., Van den Keybus, N., & Paul, L. (2011). Pain neurophysiology education improves cognitions, pain thresholds and movement performance in people with chronic whiplash: a pilot study. Journal of rehabilitation research and development, 48(1), 43-58.

Van Wambeke, P., Desomer, A., Ailiet, L., Berquin, A., Dumoulin, C., Depreitere, B., . . . Fraselle, V. (2017). Low back pain and radicular pain: assessment and management. KCE Report, 287.

Wheeler, C. H. B., Williams, A. C. C., & Morley, S. J. (2019). Meta-analysis of the psychometric properties of the Pain Catastrophizing Scale and associations with participant characteristics. Pain, 160(9), 1946-1953. doi:10.1097/j.pain.0000000000001494

Wood, L., & Hendrick, P. A. (2019). A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability. Eur J Pain, 23(2), 234-249. doi:10.1002/ejp.1314


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