Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial

Malfliet, Anneleen; Kregel, Jeroen; Coppieters, Iris; De Pauw, Robby; Meeus, Mira; Roussel, Nathalie; Cagnie, Barbara; Danneels, Lieven; Nijs, Jo

doi:10.1001/jamaneurol.2018.0492

Cited by 272Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial

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Malfliet, Anneleen, Kregel, Jeroen, Coppieters, Iris, De Pauw, Robby, Meeus, Mira, Roussel, Nathalie, Cagnie, Barbara, Danneels, Lieven +1 more·2018·JAMA Neurology

DOI 10.1001/jamaneurol.2018.0492PMC PMC6145763

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Abstract

Importance: Effective treatments for chronic spinal pain are essential to reduce the related high personal and socioeconomic costs. Objective: To compare pain neuroscience education combined with cognition-targeted motor control training with current best-evidence physiotherapy for reducing pain and improving functionality, gray matter morphologic features, and pain cognitions in individuals with chronic spinal pain. Design, Setting, and Participants: Multicenter randomized clinical trial conducted from January 1, 2014, to January 30, 2017, among 120 patients with chronic nonspecific spinal pain in 2 outpatient hospitals with follow-up at 3, 6, and 12 months. Interventions: Participants were randomized into an experimental group (combined pain neuroscience education and cognition-targeted motor control training) and a control group (combining education on back and neck pain and general exercise therapy). Main Outcomes and Measures: Primary outcomes were pain (pressure pain thresholds, numeric rating scale, and central sensitization inventory) and function (pain disability index and mental health and physical health). Results: There were 22 men and 38 women in the experimental group (mean [SD] age, 39.9 [12.0] years) and 25 men and 35 women in the control group (mean [SD] age, 40.5 [12.9] years). Participants in the experimental group experienced reduced pain (small to medium effect sizes): higher pressure pain thresholds at primary test site at 3 months (estimated marginal [EM] mean, 0.971; 95% CI, -0.028 to 1.970) and reduced central sensitization inventory scores at 6 months (EM mean, -5.684; 95% CI, -10.589 to -0.780) and 12 months (EM mean, -6.053; 95% CI, -10.781 to -1.324). They also experienced improved function (small to medium effect sizes): significant and clinically relevant reduction of disability at 3 months (EM mean, -5.113; 95% CI, -9.994 to -0.232), 6 months (EM mean, -6.351; 95% CI, -11.153 to -1.550), and 12 months (EM mean, -5.779; 95% CI, -10.340 to -1.217); better mental health at 6 months (EM mean, 36.496; 95% CI, 7.998-64.995); and better physical health at 3 months (EM mean, 39.263; 95% CI, 9.644-66.882), 6 months (EM mean, 53.007; 95% CI, 23.805-82.209), and 12 months (EM mean, 32.208; 95% CI, 2.402-62.014). Conclusions and Relevance: Pain neuroscience education combined with cognition-targeted motor control training appears to be more effective than current best-evidence physiotherapy for improving pain, symptoms of central sensitization, disability, mental and physical functioning, and pain cognitions in individuals with chronic spinal pain. Significant clinical improvements without detectable changes in brain gray matter morphologic features calls into question the relevance of brain gray matter alterations in this population. Trial Registration: clinicaltrials.gov Identifier: NCT02098005.

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This form of pain education was developed in Australia and has been adapted in numerous Western countries, demonstrating mixed results for effectiveness for managing LBP.
“This form of pain education (widely known as ‘Explain Pain’ or ‘Pain Neuroscience Education’)15–24 was developed in Australia and has been adapted in numerous Western countries, demonstrating mixed results for effectiveness for managing LBP.15 17 21 23–25”
From Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: the Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial (2019) · cites this paper as [17]

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Bonatesta, L., Ruiz-Cárdenas, J. D., Fernández-Azorín, L., & Rodríguez-Juan, J. J. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.09.006 · Cited by 41 · see citing works
Cognitive functional therapy compared with core exercise and manual therapy in patients with chronic low back pain: randomised controlled trial
Castro, J., Correia, L. C. L., Donato, B. D. S., Arruda, B., Agulhari, F., Pellegrini, M. J., Belache, F. T. C., de Souza, C. P., Fernandez, J., Nogueira, L. A. C., et al. (2022) · Pain · doi:10.1097/j.pain.0000000000002644 · Cited by 42 · see citing works
Mechanisms of education and graded sensorimotor retraining in people with chronic low back pain: a mediation analysis
Cashin, A. G., Lee, H., Wand, B. M., Bagg, M. K., O’Hagan, E. T., Rizzo, R. R. N., Stanton, T. R., Moseley, G. L., & McAuley, J. H. (2023) · Pain · doi:10.1097/j.pain.0000000000002978 · Cited by 41 · see citing works
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
Salazar‐Méndez, J., Núñez‐Cortés, R., Suso‐Martí, L., Ribeiro, I. L., Garrido-Castillo, M., Gacitúa, J., Méndez-Rebolledo, G., Cruz‐Montecinos, C., López‐Bueno, R., & Calatayud, J. (2023) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2023.105328 · Cited by 41 · see citing works
Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol
Galán-Martín, M. Á., Montero-Cuadrado, F., Lluch‐Girbés, E., Coca-López, M. C., Mayo-Íscar, A., & Vargas, A. I. C. (2019) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-019-2889-1 · Cited by 45 · see citing works
Influence of Baseline Kinesiophobia Levels on Treatment Outcome in People With Chronic Spinal Pain
Bogaert, W. V., Coppieters, I., Kregel, J., Nijs, J., Pauw, R. D., Meeus, M., Cagnie, B. J., Danneels, L. A., & Malfliet, A. (2021) · Physical Therapy · doi:10.1093/ptj/pzab076 · Cited by 41 · see citing works
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Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial
Sidiq, M., Muzaffar, T., Janakiraman, B., Masoodi, S. R., Vasanthi, R. K., Ramachandran, A., Bansal, N., Chahal, A., Kashoo, F. Z., Rizvi, M. R., et al. (2024) · PLoS ONE · doi:10.1371/journal.pone.0294302 · Cited by 47 · see citing works
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
Núñez‐Cortés, R., Salazar‐Méndez, J., Calatayud, J., Malfliet, A., Lluch, E., Méndez-Rebolledo, G., Guzmán-Muñoz, E., López‐Bueno, R., & Suso‐Martí, L. (2023) · Pain · doi:10.1097/j.pain.0000000000003126 · Cited by 39 · see citing works
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‘Your spine is so worn out’ – the influence of clinical diagnosis on beliefs in patients with non-specific chronic low back pain – a qualitative study’
Bonfim, I. D. S., Corrêa, L. A., Nogueira, L. A. C., Meziat‐Filho, N., dos Reis, F. J. J., & de Almeida, R. S. (2021) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2021.07.001 · Cited by 37 · see citing works
Can Central Sensitization After Injury Persist as an Autonomous Pain Generator? A Comprehensive Search for Evidence
Brazenor, G. A., Malham, G. M., & Teddy, P. J. (2021) · Pain Medicine · doi:10.1093/pm/pnab319 · Cited by 36 · see citing works
Pain Neuroscience Education: Teaching People About Pain
Louw, A., & Riera-Gilley, V. (2024) · Journal of Pain & Palliative Care Pharmacotherapy · doi:10.1080/15360288.2024.2424853 · Cited by 36 · see citing works
Reconsidering Fordyce's classic article, “Pain and suffering: what is the unit?” to help make our model of chronic pain truly biopsychosocial
Sullivan, M. D., Sturgeon, J. A., Lumley, M. A., & Ballantyne, J. C. (2022) · Pain · doi:10.1097/j.pain.0000000000002748 · Cited by 35 · see citing works
Behavior Change Following Pain Neuroscience Education in Middle Schools: A Public Health Trial
Louw, A., Landrus, R., Podolak, J., Benz, P., DeLorenzo, J., Davis, C., Rogers, A., Cooper, K., Louw, C., Zimney, K. J., et al. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17124505 · Cited by 35 · see citing works
Pain Neuroscience Education for Children with Functional Abdominal Pain Disorders: A Randomized Comparative Pilot Study
Pas, R., Rheel, E., Oosterwijck, S. V., Foubert, A., Pauw, R. D., Leysen, L., Roete, A., Nijs, J., Meeus, M., & Ickmans, K. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061797 · Cited by 33 · see citing works
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Effectiveness of patient education plus motor control exercise versus patient education alone versus motor control exercise alone for rural community-dwelling adults with chronic low back pain: a randomised clinical trial
Ibrahim, A. A., Akindele, M. O., & Ganiyu, S. O. (2023) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-06108-9 · Cited by 34 · see citing works
Effect of perioperative pain neuroscience education in people undergoing surgery for lumbar radiculopathy: a multicentre randomised controlled trial
Huysmans, E., Goudman, L., Coppieters, I., Bogaert, W. V., Moens, M., Buyl, R., Nijs, J., Louw, A., Logghe, T., Putman, K. D., et al. (2023) · British Journal of Anaesthesia · doi:10.1016/j.bja.2023.05.007 · Cited by 33 · see citing works
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Diverse Role of Biological Plasticity in Low Back Pain and Its Impact on Sensorimotor Control of the Spine
Hodges, P. W., Barbe, M. F., Loggia, M. L., Nijs, J., & Stone, L. S. (2019) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2019.8716 · Cited by 33 · see citing works
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Failed Back Surgery Syndrome: No Longer a Surgeon’s Defeat—A Narrative Review
Miekisiak, G. J. (2023) · Medicina · doi:10.3390/medicina59071255 · Cited by 32 · see citing works
The Relationship between Cognitive and Emotional Factors and Healthcare and Medication Use in People Experiencing Pain: A Systematic Review
Huysmans, E., Leemans, L., Beckwée, D., Nijs, J., Ickmans, K., Moens, M., Goudman, L., Buyl, R., Putman, K. D., & Coppieters, I. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9082486 · Cited by 32 · see citing works
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Effects of pain neuroscience education on kinesiophobia in patients with chronic pain: a systematic review and meta-analysis
Kim, H., & Lee, S. (2020) · Physical Therapy Rehabilitation Science · doi:10.14474/ptrs.2020.9.4.309 · Cited by 34 · see citing works
The effectiveness and safety of physical activity and exercise on women with endometriosis: A systematic review and meta-analysis
Xie, M., Qing, X., Huang, H., Zhang, L., Tu, Q., Guo, H., & Zhang, J. (2025) · PLoS ONE · doi:10.1371/journal.pone.0317820 · Cited by 31 · see citing works
Effect of perioperative pain neuroscience education in patients with post-mastectomy persistent pain: a retrospective, propensity score-matched study
Manfuku, M., Nishigami, T., Mibu, A., Yamashita, H., Imai, R., Tanaka, K., Kitagaki, K., Kanamori, H., & Sumiyoshi, K. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06103-1 · Cited by 31 · see citing works
Lumbar spondylolisthesis: STATE of the art on assessment and conservative treatment
Vanti, C., Ferrari, S., Guccione, A. A., & Pillastrini, P. (2021) · Archives of Physiotherapy · doi:10.1186/s40945-021-00113-2 · Cited by 32 · see citing works
A Call for Improving Research on Pain Neuroscience Education and Chronic Pain: An Overview of Systematic Reviews
Martínez-Calderón, J., Ho, E. K., Ferreira, P. H., García‐Muñoz, C., Villar-Alises, O., & Matias-Soto, J. (2023) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2023.11833 · Cited by 30 · see citing works
Evaluation of the Effectiveness of Dry Needling in the Treatment of Myogenous Temporomandibular Joint Disorders
Zakkour, J. D., Fraile, J. F., Montero, J., Zakkour, S. D., & Dib-Zaitun, I. (2022) · Medicina · doi:10.3390/medicina58020256 · Cited by 29 · see citing works
Feasibility and pilot testing of a personalized eHealth intervention for pain science education and self-management for breast cancer survivors with persistent pain: a mixed-method study
Groef, A. D., Evenepoel, M., Dijck, S. V., Dams, L., Haenen, V., Wiles, L., Catley, M. J., Vogelzang, A. R., Olver, I., Hibbert, P. D., et al. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-022-07557-7 · Cited by 27 · see citing works
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Blended-Learning Pain Neuroscience Education and Exercise in High School Students With Chronic Neck Pain: A Randomized Controlled Trial
Andias, R., Sá‐Couto, P., & Silva, A. G. (2022) · Physical Therapy · doi:10.1093/ptj/pzac048 · Cited by 28 · see citing works
The added value of cognitive behavioral therapy for insomnia to current best evidence physical therapy for chronic spinal pain: protocol of a randomized controlled clinical trial
Malfliet, A., Bilterys, T., Looveren, E. V., Meeus, M., Danneels, L. A., Ickmans, K., Cagnie, B. J., Maîresse, O., Neu, D., Moens, M., et al. (2018) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2018.10.007 · Cited by 27 · see citing works
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Effects of spinal stabilization exercises delivered using telerehabilitation on outcomes in patients with chronic neck pain: a randomized controlled trial
Onan, D., Ülger, Ö., & Martelletti, P. (2023) · Expert Review of Neurotherapeutics · doi:10.1080/14737175.2023.2192870 · Cited by 24 · see citing works
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
Murillo, C., Galán-Martín, M. Á., Montero-Cuadrado, F., Lluch, E., Meeus, M., & Loh, W. W. (2023) · Pain · doi:10.1097/j.pain.0000000000002929 · Cited by 25 · see citing works
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Clinimetrics: The Central Sensitisation Inventory: a useful screening tool for clinicians, but not the gold standard
Nijs, J., & Huysmans, E. (2021) · Journal of physiotherapy · doi:10.1016/j.jphys.2021.10.004 · Cited by 25 · see citing works
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It Hurts to Move! Intervention Effects and Assessment Methods for Movement-Evoked Pain in Patients With Musculoskeletal Pain: A Systematic Review with Meta-analysis
Leemans, L., Polli, A., Nijs, J., Wideman, T. H., den Bandt, H. L., & Beckwée, D. (2022) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2022.10527 · Cited by 25 · see citing works
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A paradigm shift from a tissue- and disease-based approach towards multimodal lifestyle interventions for chronic pain: 5 steps to guide clinical reasoning
Nijs, J., Lahousse, A., & Malfliet, A. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100556 · Cited by 25 · see citing works
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Central sensitisation: another label or useful diagnosis?
Nijs, J., Polli, A., Willaert, W., Malfliet, A., Huysmans, E., & Coppieters, I. (2019) · Drug and Therapeutics Bulletin · doi:10.1136/dtb.2018.000035 · Cited by 24 · see citing works
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Understanding the clinical profile of patients with frozen shoulder: a longitudinal multicentre observational study
Mertens, M. G., Meeus, M., Noten, S., Verborgt, O., Fransén, E., Girbés, E. L., Rodríguez, M. A., Ledesma, S. N., Fernández-Sánchez, M., Luque-Suárez, A., et al. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056563 · Cited by 24 · see citing works
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Affordance-based practice: An ecological-enactive approach to chronic musculoskeletal pain management
Vaz, D. V., Stilwell, P., Coninx, S., Low, M., & Liebenson, C. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100554 · Cited by 26 · see citing works
Can we just talk our patients out of pain? Should pain neuroscience education be our only tool?
Shala, R., Roussel, N. A., Moseley, G. L., Osinski, T., & Puentedura, E. J. (2021) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2021.1873259 · Cited by 24 · see citing works
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Cognitive Behavioral Therapy for Insomnia in Pain Management for Nonspecific Chronic Spinal Pain
Malfliet, A., Baets, L. D., Bilterys, T., Looveren, E. V., Maîresse, O., Cagnie, B. J., Meeus, M., Moens, M., Goubert, D., Munneke, W., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.25856 · Cited by 22 · see citing works
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An Educational and Exercise Mobile Phone–Based Intervention to Elicit Electrophysiological Changes and to Improve Psychological Functioning in Adults With Nonspecific Chronic Low Back Pain (BackFit App): Nonrandomized Clinical Trial
Sitges, C., Terrasa, J. L., García-Dopico, N., Segur-Ferrer, J., Roldán, O. V., Crespí-Palmer, J., González‐Roldán, A. M., & Montoya, P. (2022) · JMIR mhealth and uhealth · doi:10.2196/29171 · Cited by 22 · see citing works
Soft-Tissue Mobilization and Pain Neuroscience Education for Chronic Nonspecific Low Back Pain with Central Sensitization: A Prospective Randomized Single-Blind Controlled Trial
Song, J. K., Kim, H., Jung, J., & Lee, S. (2023) · Biomedicines · doi:10.3390/biomedicines11051249 · Cited by 21 · see citing works
Carryover Effects of Pain Neuroscience Education on Patients with Chronic Lower Back Pain: A Systematic Review and Meta-Analysis
Shin, S., & Kim, H. (2023) · Medicina · doi:10.3390/medicina59071268 · Cited by 21 · see citing works
Combining Stress Management With Pain Neuroscience Education and Exercise Therapy in People With Whiplash-Associated Disorders: A Clinical Perspective
Willaert, W., Leysen, L., Lenoir, D., Meeus, M., Cagnie, B. J., Nijs, J., Sterling, M. M., & Coppieters, I. (2021) · Physical Therapy · doi:10.1093/ptj/pzab105 · Cited by 20 · see citing works
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Neuroscience Education as Therapy for Migraine and Overlapping Pain Conditions: A Scoping Review
Minen, M. T., Kaplan, K., Akter, S., Espinosa-Polanco, M., Guiracocha, J., Khanns, D., Corner, S. E., & Roberts, T. R. (2021) · Pain Medicine · doi:10.1093/pm/pnab131 · Cited by 20 · see citing works
Pilot study on the effects of a culturally-sensitive and standard pain neuroscience education for Hausa-speaking patients with chronic neck pain
Mukhtar, N. B., Meeus, M., Gürşen, C., Mohammed, J., Pauw, R. D., & Cagnie, B. J. (2021) · Disability and Rehabilitation · doi:10.1080/09638288.2021.1988155 · Cited by 20 · see citing works
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Virtual Reality Therapy for the Management of Chronic Spinal Pain: Systematic Review and Meta-Analysis
Zhang, T., Li, X., Zhou, X., Zhan, L., Wu, F., Huang, Z., Sun, Y., Feng, Y., & Du, Q. (2024) · JMIR Serious Games · doi:10.2196/50089 · Cited by 20 · see citing works
Psychological interventions for women with persistent pelvic pain: A survey of mental health clinicians
Brooks, T., Sharp, R., Evans, S., Baranoff, J., & Esterman, A. (2021) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s313109 · Cited by 19 · see citing works
Neuromuscular exercise and pain neuroscience education compared with pain neuroscience education alone in patients with chronic pain after primary total knee arthroplasty: study protocol for the NEPNEP randomized controlled trial
Larsen, J. B., Skou, S. T., Arendt‐Nielsen, L., Simonsen, O. H., & Madeleine, P. (2020) · Trials · doi:10.1186/s13063-020-4126-5 · Cited by 19 · see citing works
Does m-health-based exercise (guidance plus education) improve efficacy in patients with chronic low-back pain? A preliminary report on the intervention’s significance
Zheng, F., Liu, S., Zhang, S., Yu, Q., Lo, W. L. A., Li, T., & Wang, C. (2022) · Trials · doi:10.1186/s13063-022-06116-z · Cited by 19 · see citing works
Pain neuroscience education for patients with chronic pain: A scoping review from teaching–learning strategies, educational level, and cultural perspective
Salazar‐Méndez, J., Cuyúl-Vásquez, I., Ponce‐Fuentes, F., Guzmán-Muñoz, E., Núñez‐Cortés, R., Huysmans, E., Lluch‐Girbés, E., Viscay‐Sanhueza, N., & Fuentes, J. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108201 · Cited by 19 · see citing works
Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis
Cano-Sánchez, J., Aibar‐Almazán, A., Hita‐Contreras, F., Afanador-Restrepo, D. F., Martínez‐Amat, A., Achalandabaso‐Ochoa, A., & Carcelén‐Fraile, M. D. C. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13051378 · Cited by 19 · see citing works
Chronic Primary Pain of the Spine: an Integrative Perspective Part 2
Williamson, T. J., Bolles, C. L., Hedges, N. A., & Kettner, N. W. (2021) · SN Comprehensive Clinical Medicine · doi:10.1007/s42399-021-00779-6 · Cited by 11 · see citing works
The effect of preoperative education on postoperative pain and function after orthopedic surgery: A systematic review and meta-analysis
Wang, F., Zhang, J., Guan, Y., & Xie, J. (2024) · Patient Education and Counseling · doi:10.1016/j.pec.2024.108406 · Cited by 19 · see citing works
Learning the neurobiology of pain: A scoping review of pain education from an instructional design perspective
Ziegler, A.-M. L., Minkalis, A. L., Langdon, E. R., & Vining, R. D. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.09.021 · Cited by 19 · see citing works
Examining the influence of pain neuroscience education followed by a Pilates exercises program in individuals with knee osteoarthritis: a pilot randomized controlled trial
Rabiei, P., Sheikhi, B., & Letafatkar, A. (2023) · Arthritis Research & Therapy · doi:10.1186/s13075-023-03079-7 · Cited by 18 · see citing works
Illness perceptions in people with chronic and disabling non-specific neck pain seeking primary healthcare: a qualitative study
Kragting, M., Pool‐Goudzwaard, A., Coppieters, M. W., O’Sullivan, P., & Voogt, L. P. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07302-7 · Cited by 18 · see citing works
Physical Therapy Considerations and Recommendations for Patients Following Spinal Cord Stimulator Implant Surgery
Tekmyster, G., Jonely, H., Lee, D. W., Myerson, J., Avery, M., Moradian, M., & Desai, M. J. (2021) · Neuromodulation Technology at the Neural Interface · doi:10.1111/ner.13391 · Cited by 18 · see citing works
Effect of pain neuroscience education and exercise on presenteeism and pain intensity in health care workers: A randomized controlled trial
Imai, R., Konishi, T., Mibu, A., Tanaka, K., & Nishigami, T. (2021) · Journal of Occupational Health · doi:10.1002/1348-9585.12277 · Cited by 17 · see citing works
Pain neuroscience education improves post-traumatic stress disorder, disability, and pain self-efficacy in veterans and service members with chronic low back pain: Preliminary results from a randomized controlled trial with 12-month follow-up
Benedict, T., Nitz, A. J., Gambrel, M. K., & Louw, A. (2023) · Military Psychology · doi:10.1080/08995605.2023.2188046 · Cited by 18 · see citing works
Multimodal management strategies for chronic pain after spinal surgery: a comprehensive review
Yoon, J.-P., Shon, H.-S., Lee, J., & Byeon, G. (2024) · Anesthesia and Pain Medicine · doi:10.17085/apm.23122 · Cited by 17 · see citing works
Effects of Manual Therapy Plus Pain Neuroscience Education with Integrated Motivational Interviewing in Individuals with Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial Study
Kasimis, K., Apostolou, T. S., Kallistratos, I., Lytras, D., & Iakovidis, P. (2024) · Medicina · doi:10.3390/medicina60040556 · Cited by 18 · see citing works
Interrelationships of disease activity, central sensitization, psychosocial and lifestyle factors in axial spondyloarthritis
Kieskamp, S. C., van der Kraan, Y. M., Arends, S., Wink, F., Bos, R., Stewart, R. E., Paap, D., & Spoorenberg, A. J. P. L. (2025) · Lara D. Veeken · doi:10.1093/rheumatology/keaf102 · Cited by 16 · see citing works
Do psychological factors relate to movement-evoked pain in people with musculoskeletal pain? A systematic review and meta-analysis
Leemans, L., Nijs, J., Antonis, L., Wideman, T. H., den Bandt, H. L., Franklin, Z. C., Mullie, P., Moens, M., Joos, E., & Beckwée, D. (2022) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2022.100453 · Cited by 16 · see citing works
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The effectiveness of a combined exercise and psychological treatment programme on measures of nervous system sensitisation in adults with chronic musculoskeletal pain - a systematic review and meta-analysis.
Deegan, O., Fullen, B. M., Segurado, R., & Doody, C. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07274-8 · Cited by 16 · see citing works
Effects of pain neuroscience education and rehabilitation following arthroscopic rotator cuff repair. A randomized clinical trial
Ponce‐Fuentes, F., Cuyúl-Vásquez, I., Medina, L., & Fuentes, J. (2022) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2022.2061394 · Cited by 15 · see citing works
Effectiveness of adding pain neuroscience education to telerehabilitation in patients with carpal tunnel syndrome: A randomized controlled trial
Núñez‐Cortés, R., Cruz‐Montecinos, C., Torreblanca-Vargas, S., Tapia, C., Gutiérrez-Jiménez, M., Torres-Gangas, P., Calatayud, J., & Pérez‐Alenda, S. (2023) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2023.102835 · Cited by 15 · see citing works
The clinical impact of pain neuroscience continuing education on physical therapy outcomes for patients with low back and neck pain
Louw, A., Puentedura, E. J., Denninger, T. R., Lutz, A. D., Cox, T., Zimney, K. J., & Landers, M. R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0267157 · Cited by 16 · see citing works
Influence of education level on the effectiveness of pain neuroscience education: A secondary analysis of a randomized controlled trial
Bilterys, T., Kregel, J., Nijs, J., Meeus, M., Danneels, L. A., Cagnie, B. J., Looveren, E. V., & Malfliet, A. (2021) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2021.102494 · Cited by 13 · see citing works
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Effect of pain neuroscience education+ (PNE+) in people with different mechanisms of chronic pain: A systematic review and meta-analysis
Tatikola, S. P., Natarajan, V., Amaravadi, S. K., Desai, V. K., Asirvatham, A. R., & Nagaraja, R. (2024) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2024.11.016 · Cited by 14 · see citing works
Exercise therapy and physical activity in the paradigm shift from a tissue- and disease-based pain management approach towards multimodal lifestyle interventions for chronic pain
Nijs, J., Mostaqim, K., & Oostendorp, R. A. B. (2024) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2024.101101 · Cited by 13 · see citing works
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Comparative Effectiveness and Safety of Concomitant Treatment with Chuna Manual Therapy and Usual Care for Whiplash Injuries: A Multicenter Randomized Controlled Trial
Kim, B.-J., Park, A., Hwang, M., Heo, I., Park, S., Cho, J., Kim, K., Lee, J., Ha, I., Park, K.-S., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191710678 · Cited by 13 · see citing works

A Modern Neuroscience Approach to Chronic Spinal Pain: Combining Pain Neuroscience Education With Cognition-Targeted Motor Control Training
Nijs, J., Meeus, M., Cagnie, B., Roussel, N. A., Dolphens, M., Van Oosterwijck, J., & Danneels, L. (2014) · Physical Therapy · doi:10.2522/ptj.20130258 · Cited by 190 · see citing works
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Effect Of Pain Neuroscience Education Followed By Cognition-Targeted Motor Control Training On Pain, Disability, Central Sensitization And Kinesiophobia In Patient With Nonspecific Chronic Low Back Pain
Letafatkar, A., Amini, F., & Sheikhi, B. (2024) · Research in Sport Medicine and Technology · doi:10.61186/jsmt.22.27.135
Does Pain Neuroscience Education and Cognition‐Targeted Motor Control Training Improve Cervical Motor Output? Secondary Analysis of a Randomized Clinical Trial
Willaert, W., Malfliet, A., Coppieters, I., Lenoir, D., Pauw, R. D., Danneels, L. A., Roussel, N. A., Meeus, M., Cagnie, B. J., Nijs, J., et al. (2020) · Pain Practice · doi:10.1111/papr.12884 · Cited by 11 · see citing works
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Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial
Dolphens, M., Nijs, J., Cagnie, B. J., Meeus, M., Roussel, N. A., Kregel, J., Malfliet, A., Vanderstraeten, G., & Danneels, L. A. (2014) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-15-149 · Cited by 44 · see citing works
Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial
Galán-Martín, M. Á., Montero-Cuadrado, F., Lluch‐Girbés, E., Coca-López, M. C., Mayo-Íscar, A., & Vargas, A. I. C. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9041201 · Cited by 101 · see citing works

Authors: Malfliet, A., Kregel, J., Coppieters, I., De Pauw, R., Meeus, M., Roussel, N., Cagnie, B., Danneels, L., & Nijs, J.
Affiliations: Vrije Universiteit Brussel (BE)
Ghent University (BE)
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Campus Heymans, Ghent, Belgium
University of Antwerp (BE)
Corresponding author: Malfliet, Anneleen
ORCID: Malfliet, Anneleen
Kregel, Jeroen
Coppieters, Iris
Meeus, Mira
Roussel, Nathalie
Cagnie, Barbara
Danneels, Lieven
Nijs, Jo
Venue: JAMA Neurology
Publisher: American Medical Association (AMA)
Published: 2018-07-01
Volume: 75
Issue: 7
Pages: 808
ISSN: 2168-6149 (ISSN-L)
DOI: 10.1001/jamaneurol.2018.0492
PMC: PMC6145763
OpenAlex: W2797034756
Cited by: 272
References: 37
Citations by year: 2026: 21 · 2025: 30 · 2024: 56 · 2023: 43 · 2022: 32 · 2021: 33 · 2020: 29 · 2019: 25 · 2018: 3
FWCI: 14.41
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: JAMA Neurology (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Ghent University Academic Bibliography (Ghent University) (submittedVersion)
VUBIR (Vrije Universiteit Brussel) (submittedVersion)
Funders: Fonds Wetenschappelijk Onderzoek
Vlaamse regering
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords: pain neuroscience education, chronic non-specific low back pain, chronic neck pain, central sensitization, pain-related cognitions, pressure pain threshold, pain-related disability, gray matter morphology, physiotherapy, exercise therapy, mental health, physical health, cognitive behavioral therapy, pain catastrophizing, fear avoidance
MeSH terms: Adult, Back Pain, Cognition, Exercise Therapy, Female, Humans, Male, Middle Aged, Neurosciences, Patient Education as Topic, Whiplash Injuries, Low Back Pain, Neck Pain, Physical Therapy Modalities, Failed Back Surgery Syndrome, Central Nervous System Sensitization, Chronic Pain, Gray Matter

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Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal Pain: A Randomized Clinical Trial

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