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

Marris, Danielle; Theophanous, Kyriakos; Cabezon, Pablo; Dunlap, Zachary; Donaldson, Megan

doi:10.1080/09593985.2019.1633714

Cited by 113Musculoskeletal pain and rehabilitationPain Management and TreatmentMedical Practices and Rehabilitation

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

Marris, Danielle, Theophanous, Kyriakos, Cabezon, Pablo, Dunlap, Zachary, Donaldson, Megan·2021·Physiotherapy Theory and Practice

DOI 10.1080/09593985.2019.1633714

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Abstract

Study Design: Systematic Review with meta-analysis.Background: Rehabilitation providers have begun to incorporate pain education into their treatment protocols to influence the patient’s experience and knowledge to improve their condition. The purpose of this systematic review is to determine if the addition of pain education strategies to physical therapy treatments is beneficial in reducing pain intensity and disability for those with chronic musculoskeletal pain.Methods: A systematic database search was conducted for randomized control trials that investigated the concurrent use of pain education and physical therapy. Standardized methods for article identification, inclusion, and quality appraisal was utilized. Where possible, studies were pooled for meta-analysis, with pain and disability as the primary outcomes.Results: Fourteen articles were included in this review, of which all fourteen were rated as high quality using the PEDro scale of quality assessment. Meta-analyses were conducted on pain and disability constructs at short term (< 12 weeks) and long-term (≥ 12 weeks) for the studies that allowed for quantitative pooling of effect sizes. Thirteen out of the fourteen included studies demonstrated a decrease in pain and disability with the use of combined interventions. There was a large effect on short-term pain (SMD 0.837), long-term pain (SMD 0.964), and long-term disability (SMD 1.374). A moderate effect on with short-term disability (SMD 0.791).Conclusion: The results of this systematic review support the conclusion that utilizing pain education strategies in conjunction with interventions provided by physical therapists demonstrates a moderate to large effect sizes on pain and disability constructs but lack pooled statistical significance.

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Physical therapies can significantly reduce pain-related distress, especially when applied along with educational interventions.
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From A Single-Session Process-Based Cognitive-Behavioral Intervention Combined with Multimodal Rehabilitation Treatment for Chronic Pain Associated with Emotional Disorders (2024) · cites this paper as [129]

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Decoding chronic pain: insights into the transition from acute to persistent pain
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Accessibility of psychological treatments for chronic pain in low socioeconomic settings
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A conceptual model for managing sexual pain with somatocognitive therapy in women with provoked vestibulodynia and implications for physiotherapy practice
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“A recent systematic review found a significant reduction in pain and disability when pain education was combined with traditional physiotherapy among patients with chronic pain (Marris et al., 2021).”
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Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study
Honda, H., Ashizawa, R., Kameyama, Y., Hirase, T., Arizono, S., & Yoshimoto, Y. (2024) · European Geriatric Medicine · doi:10.1007/s41999-024-00965-4 · Cited by 5 · see citing works
“How can we help you?”: results of a scoping review on the perceived needs of people living with chronic pain regarding physiotherapy
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Pain Education in the Context of Non‐Specific Low Back Pain: The Lived Experience of the Physiotherapist. An Interpretive Phenomenological Analysis
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A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases
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“Recent systematic reviews reported greater effectiveness of multidisciplinary rehabilitation with better patient education than exercise therapy alone [23].”
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Are physical therapy interventions effective in improving sleep in people with chronic pain? A systematic review and multivariate meta-analysis
Calvo, S., González, C., Lapuente‐Hernández, D., Cuenca‐Zaldívar, J. N., Herrero, P., & Gil-Calvo, M. (2023) · Sleep Medicine · doi:10.1016/j.sleep.2023.09.008 · Cited by 5 · see citing works
Recovering Work Productivity in a Population With Chronic Musculoskeletal Pain
Janela, D., Areias, A. C., Moulder, R. G., Jr., Molinos, M., Bento, V., Yanamadala, V., Correia, F. D., & Costa, F. M. T. A. (2024) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000003191 · Cited by 4 · see citing works
“46 The overall work impairment at baseline was similar across GIFO, GP, EH, and TTU industry sectors (~33.2, SD 23.1), despite the increased prevalence of disability risk factors in particular industries: GIFO had a higher prevalence of patients >60 years old, GP and TTU had a higher proportion of…”
Influential
Reasons for patient no-shows and drop-offs after initial evaluation in physical therapy outpatient care: a qualitative study
Thomas, A. C., Shaver, S. N., Young, J. L., & Cook, C. E. (2025) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2025.103326 · Cited by 6 · see citing works
Health Literacy Development among People with Chronic Diseases: Advancing the State of the Art and Learning from International Practices
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Preliminary efficacy and predictors of response to a remotely-delivered symptom self-management program for persistent symptoms after concussion
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Effectiveness of pain neuroscience education among adults with chronic neck pain. Systematic review
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“As for other chronic pain reviews [39,40,43,44], another possible reason could be the PNE doses, since out of four studies [32–34,37] discussing pain intensity, only one [ 37] As for self-efficacy, the results in this review differ from the ones in previous study [47].”
A Cross-Sectional Study on Current Perioperative Pain Management and Nurses’ Pain Management Self-Efficacy in China’s Interventional Department
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“23,24 Non-Pharmacological Pain Management Strategies Non-pharmacological pain management strategies, such as psychological support (96.9”
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Pain Neuroscience Education and Neuroimaging—A Narrative Review
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“Another systematic review and meta-analysis on chronic pain [37] included 14 studies (number of participants = 1024), and investigated the impact of combining pain education strategies (PNE and cognitive behavioral therapy) with physical therapy interventions.”
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Democratizing access to physical therapy to address the challenge of chronic pain
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Community-based Participatory Action Research Approach for the Development of an Arabic Culturally Sensitive Pain Neuroscience Education: A Qualitative Focus Group Study with Physical Therapists and Individuals with Chronic Low Back Pain in Lebanon.
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The role of the patient–clinician relationship in Chronic Pain Interventions: A systematic review
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Pain education to women with fibromyalgia using the DolorÔmetro game
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Self-Management and Low Back Pain
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What are the perceived needs of people living with chronic pain regarding physiotherapy services? A scoping review protocol
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“Among the healthcare services offered to people living with chronic pain, physiotherapy is effective in reducing pain, improving quality of life and function, and decreasing opioids intake [20, 21].”
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Measurement of physical activity and prevention of physical inactivity/sedentary behaviors in patients with septic knee arthritis before and after hospital discharge: A case report
Kaizu, Y., Tajika, K., & Miyata, K. (2022) · Physiotherapy Research International · doi:10.1002/pri.1943 · Cited by 2 · see citing works
The efficacy of extracorporeal shock wave for chronic musculoskeletal pain conditions
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“Chronic musculoskeletal pain conditions (CMPC) is a common public health problem that affects about 20% adult population worldwide, causing a serious economic burden and high absenteeism rate.([1,2]) Over 55% visits to their doctors were for pain-related problem (joint disorders and back problems) in USA.”
Background
Patient and Provider Perspectives on Barriers and Facilitators to the Acceptance of Pain Neuroscience Education in Chronic Musculoskeletal Pain Conditions: A Qualitative Systematic Review Protocol
Kühn, L., Reiter, N. L., Wengemuth, E., & Choi, K. (2024) · Applied Sciences · doi:10.3390/app14020571 · Cited by 2 · see citing works
The association between physical intervention use and treatment outcomes in patients participating in an online and psychologically informed pain management program
McNaughton, D. T., Hancock, M. J., Bisby, M. A., Scott, A. J., Jones, M. P., & Dear, B. F. (2024) · Pain Medicine · doi:10.1093/pm/pnae044 · Cited by 1 · see citing works
Enablers, Barriers and Practical Applications of a Group‐Based Pain Self‐Management Program for Patients Receiving Medical Cannabis: A Qualitative Study of Patients and Clinicians
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Embedding expectation effects on the management of cancer pain and related symptoms: A focus review
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Case Report: Introducing @tension—a system for improving adherence to exposure therapy in chronic pain patients
Berkowitz, S., Sivan-Speier, K., Bartur, G., Fortinsky, H., Lawee, B. A., & Shahaf, G. (2026) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2026.1708612 · Cited by 1 · see citing works
Therapeutic Education and Physiotherapy in Low Back Pain Management
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“Several guidelines and systematic reviews recommend TE based on neurophysiological pain education (NPE) as an effective part of the complex therapy in chronic LBP management [3], [10], [11], [12].”
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Design of a Health Education Program to Manage Chronic Neck Pain: Protocol for a Development Study
Pérez-Muñoz, M., Rodríguez‐Costa, I., Lebrijo-Pérez, G., Pecos‐Martín, D., Gallego‐Izquierdo, T., & Pérez-Martín, Y. (2024) · JMIR Research Protocols · doi:10.2196/56632 · Cited by 1 · see citing works
“These interventions usually yield positive results in the short and medium term, reducing pain intensity and functional disability while improving the quality of life for individuals with chronic pain, compared to conventional physiotherapy interventions [48,52-55].”
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Perspectives of Pain Specialists, Patients, and Family Members on Long-Term Opioid use for Chronic Non- Cancer Pain: A Qualitative StudyPreprint
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Effects of pain neuroscience training combined with neuromuscular exercises on pain, functional disability and psychological factors related to chronic low back pain: A study protocol for a single-blind randomized controlled trialPreprint
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Brief interprofessional intervention for chronic pain management: a pilot study
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Intervenção interprofissional breve para manejo da dor crônica: estudo piloto
Ali, Y. C. M. M., Gouvêa, À. L., de Oliveira, M. S., Martini, S., Ashmawi, H. A., & Salvetti, M. D. G. (2022) · Revista da Escola de Enfermagem da USP · doi:10.1590/1980-220x-reeusp-2021-0450pt
Genitale pijn bij mannen
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Online-Schmerzedukation verstärkt die positiven Auswirkungen eines Online-Trainingsprogramms gegen Rückenschmerzen
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Neta, M. A. L. P., da Nóbrega, D. L. S., Silva, E. C. L., Miranda, L. V. L. M., Dalbom, V. C., Silva, M. C. O. D., Santos, R. T. A., Carvalho, V. S., Carvalho, R. F. V., & Santos, G. S. B. (2024) · Editora Pascal LTDA eBooks · doi:10.29327/5365952.1-4
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Neta, M. A. L. P., de Oliveira, I. F. F., Miranda, L. V. L. M., Melo, B. F., Santos, R. T. A., Csasznik, A., Carvalho, V. S., Mesquita, A. M. V., Bispo, D. D., & Santos, G. S. B. (2024) · Editora Pascal LTDA eBooks · doi:10.29327/5365952.1-2
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Neta, M. A. L. P., da Nóbrega, D. L. S., Silva, E. C. L., Miranda, L. V. L. M., Tissot, D., Santana, K. C., Silva, M. C. O. D., Mesquita, A. M. V., Santos, R. T. A., Carvalho, V. S., et al. (2024) · Editora Pascal LTDA eBooks · doi:10.29327/5365952.1-9
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Neta, M. A. L. P., de Oliveira, I. F. F., Miranda, L. V. L. M., Santos, R. T. A., Carvalho, V. S., Csasznik, A., Mesquita, A. M. V., Pinheiro, P. H. D. G., Vale, C. E. S., & Santos, G. S. B. (2024) · Editora Pascal LTDA eBooks · doi:10.29327/5365952.1-7
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Salgado, J. E. A., Moura, E. H., Andrade, I. L. X. C., Silva, R. L., Melo, S. M., Cantinho, K. M. C. R., da Silva, E. A., Júnior, J. D. J. C., Neto, J. D. S., & Dantas, A. T. D. A. (2024) · Editora Pascal LTDA eBooks · doi:10.29327/5365952.1-3
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From Hospital to Home
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Effectiveness of Pain Neuroscience Education in Physical Therapy: A Systematic Review and Meta-Analysis
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Authors: Marris, D., Theophanous, K., Cabezon, P., Dunlap, Z., & Donaldson, M.
Affiliations: Walsh University (US)
Tufts University (US)
Corresponding author: Donaldson, Megan
ORCID: Donaldson, Megan
Venue: Physiotherapy Theory and Practice
Publisher: Informa UK Limited
Published: 2019-06-28
Volume: 37
Issue: 4
Pages: 461-472
ISSN: 0959-3985 (ISSN-L)
1532-5040
DOI: 10.1080/09593985.2019.1633714
OpenAlex: W2953819207
Cited by: 113
References: 33
Citations by year: 2026: 11 · 2025: 16 · 2024: 31 · 2023: 18 · 2022: 13 · 2021: 15 · 2020: 8 · 2019: 1
FWCI: 1.19
Type: journal article
Language: en
Open access: closed
Locations: Physiotherapy Theory and Practice (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords: pain education, physiotherapy, chronic musculoskeletal pain, pain intensity, disability, combined intervention, patient education, rehabilitation
MeSH terms: Combined Modality Therapy, Disability Evaluation, Humans, Pain Measurement, Patient Education as Topic, Randomized Controlled Trials as Topic, Physical Therapy Modalities, Chronic Pain, Musculoskeletal Pain

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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

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