A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain

Moseley, G. Lorimer; Nicholas, Michael K.; Hodges, Paul W.

doi:10.1097/00002508-200409000-00007

Cited by 537Musculoskeletal pain and rehabilitationPain Management and TreatmentPain Mechanisms and Treatments

A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain

Moseley, G. Lorimer, Nicholas, Michael K., Hodges, Paul W.·2004·The Clinical Journal of Pain

DOI 10.1097/00002508-200409000-00007

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Abstract

OBJECTIVES: Cognitive-behavioral pain management programs typically achieve improvements in pain cognitions, disability, and physical performance. However, it is not known whether the neurophysiology education component of such programs contributes to these outcomes. In chronic low back pain patients, we investigated the effect of neurophysiology education on cognitions, disability, and physical performance. METHODS: This study was a blinded randomized controlled trial. Individual education sessions on neurophysiology of pain (experimental group) and back anatomy and physiology (control group) were conducted by trained physical therapist educators. Cognitions were evaluated using the Survey of Pain Attitudes (revised) (SOPA(R)), and the Pain Catastrophizing Scale (PCS). Behavioral measures included the Roland Morris Disability Questionnaire (RMDQ), and 3 physical performance tasks; (1) straight leg raise (SLR), (2) forward bending range, and (3) an abdominal "drawing-in" task, which provides a measure of voluntary activation of the deep abdominal muscles. Methodological checks evaluated non-specific effects of intervention. RESULTS: There was a significant treatment effect on the SOPA(R), PCS, SLR, and forward bending. There was a statistically significant effect on RMDQ; however, the size of this effect was small and probably not clinically meaningful. DISCUSSION: Education about pain neurophysiology changes pain cognitions and physical performance but is insufficient by itself to obtain a change in perceived disability. The results suggest that pain neurophysiology education, but not back school type education, should be included in a wider pain management approach.

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The only current model, of energetic and personalized explanation of pain, still lacks application in mainstream pain management.
“The only current model, of energetic and personalized explanation of pain, 10 still lacks application in mainstream pain management”
From Patient action as means and end of chronic pain care: Risks and routes to meaningful action (2017) · cites this paper as [10]
Neurophysiology education led to some normalization of attitudes and beliefs about pain, a reduction in catastrophizing, and improvement in physical performance in adults.
“A previous study looking at the efficacy of brief education intervention found that neurophysiology education led to some normalization of attitudes and beliefs about pain, a reduction in catastrophizing, and improvement in physical performance [20].”
From The Effect of a Brief Physician-Delivered Neurobiologically Oriented, Cognitive Behavioural Therapy (Brief-CBT) Intervention on Chronic Pain Acceptance in Youth with Chronic Pain—A Randomized Controlled Trial. (2022) · cites this paper as [20]
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 [15]

The Pain Catastrophizing Scale: Development and validation.
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.4.524 · Cited by 8,227 · see citing works
A Study of the Natural History of Back Pain: Part I
ROLAND, M., & MORRIS, R. (1983) · Spine · doi:10.1097/00007632-198303000-00004 · Cited by 3,395 · see citing works
Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache
Morley, S., Eccleston, C., & Williams, A. (1999) · Pain · doi:10.1016/s0304-3959(98)00255-3 · Cited by 1,597 · see citing works
Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.
Flor, H., Fydrich, T., & Turk, D. C. (1992) · Pain · doi:10.1016/0304-3959(92)90145-2 · Cited by 1,227 · see citing works
Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble
Burton, A. K., Tillotson, K. M., Main, C. J., & Hollis, S. (1995) · Spine · doi:10.1097/00007632-199503150-00014 · Cited by 700 · see citing works
Information and advice to patients with back pain can have a positive effect. A randomized controlled trial of a novel educational booklet in primary care.
Burton, A., Waddell, G., Tillotson, K., & Summerton, N. (1999) · Spine · doi:10.1097/00007632-199912010-00010 · Cited by 622 · see citing works
The Dominant Role of Psychosocial Risk Factors in the Development of Chronic Low Back Pain Disability
Gatchel, R. J., Polatin, P. B., & Mayer, T. G. (1995) · Spine · doi:10.1097/00007632-199512150-00011 · Cited by 532 · see citing works
Systematic review of outpatient services for chronic pain control.
McQuay, Moore, Eccleston, Morley, & Williams, A. C. D. C. (1997) · Health Technology Assessment · doi:10.3310/hta1060 · Cited by 424 · see citing works
Comparison of cognitive-behavioral group treatment and an alternative non-psychological treatment for chronic low back pain
Nicholas, M. K., Wilson, P. H., & Goyen, J. (1992) · Pain · doi:10.1016/0304-3959(92)90082-m · Cited by 271 · see citing works
Self-citation
Prediction of pain in patients with chronic low back pain: Effects of inaccurate prediction and pain-related anxiety
McCracken, L. M., Gross, R. T., Sorg, P. J., & Edmands, T. A. (1993) · Behaviour Research and Therapy · doi:10.1016/0005-7967(93)90117-d · Cited by 254 · see citing works
Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain
Smith, L. A., Oldman, A., McQuay, H. J., & Moore, A. R. (2000) · Pain · doi:10.1016/s0304-3959(00)00234-7 · Cited by 249 · see citing works
Randomization is important in studies with pain outcomes: systematic review of transcutaneous electrical nerve stimulation in acute postoperative pain
Carroll, D., Tramèr, M. R., McQuay, H. J., Nye, B., & Moore, A. (1996) · British Journal of Anaesthesia · doi:10.1093/bja/77.6.798 · Cited by 213 · see citing works
Validity of the Active Straight Leg Raise Test for Measuring Disease Severity in Patients With Posterior Pelvic Pain After Pregnancy
Mens, J. M. A., Vleeming, A., Snijders, C. J., Koes, B. W., & Stam, H. J. (2002) · Spine · doi:10.1097/00007632-200201150-00015 · Cited by 204 · see citing works
Absence resulting from low back trouble can be reduced by psychosocial intervention at the work place
Symonds, T. L., Burton, A. K., Tillotson, K. M., & Main, C. J. (1995) · Spine · doi:10.1097/00007632-199512150-00016 · Cited by 193 · cited 2× · see citing works
“Two notable studies have evaluated education based on the biopsychosocial model, which acknowledges cognitive and behavioral factors.(33,34) One study compared 2 education booklets.”
Background
Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain.
Turner, J. A., & Clancy, S. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.56.2.261 · Cited by 192 · see citing works
The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy
Schade, V., Semmer, N. K., Main, C. J., Hora, J., & Boos, N. (1999) · Pain · doi:10.1016/s0304-3959(98)00210-3 · Cited by 187 · see citing works
Manipulative Therapy Versus Education Programs in Chronic Low Back Pain
Triano, J. J., McGregor, M., Hondras, M., & Brennan, P. C. (1995) · Spine · doi:10.1097/00007632-199504150-00013 · Cited by 187 · see citing works
Can Trials of Physical Treatments Be Blinded?
Deyo, R. A., Walsh, N. E., Schoenfeld, L. S., & Ramamurthy, S. (1990) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/00002060-199002000-00003 · Cited by 179 · see citing works
Evaluation of the relationship between laboratory and clinical tests of transversus abdominis function
Hodges, P. W., Richardson, C. A., & Jull, G. A. (1996) · Physiotherapy Research International · doi:10.1002/pri.45 · Cited by 172 · see citing works
Self-citation
Operant-behavioural and cognitive-behavioural treatment for chronic low back pain
Nicholas, M. K., Wilson, P. H., & Goyen, J. (1991) · Behaviour Research and Therapy · doi:10.1016/0005-7967(91)90112-g · Cited by 159 · see citing works
Self-citation
Comparison of operant behavioral and cognitive-behavioral group treatment for chronic low back pain.
Turner, J. A., & Clancy, S. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.2.261 · Cited by 159 · see citing works
The Effect of Hamstring Muscle Stretching on Standing Posture and on Lumbar and Hip Motions During Forward Bending
Li, Y.-C., McClure, P. W., & Pratt, N. E. (1996) · Physical Therapy · doi:10.1093/ptj/76.8.836 · Cited by 155 · see citing works
The efficacy of back schools: A review of randomized clinical trials
Koes, B. W., van Tulder, M. W., van der Windt, D. A. W. M., & Bouter, L. M. (1994) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(94)90188-0 · Cited by 151 · see citing works
Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study
Bendix, A. F., Bendix, T., VAeGTER, K., Lund, C., FRØLUND, L., & HOLM, L. (1996) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.63.1.62 · Cited by 148 · see citing works
Lumbar Supports and Education for the Prevention of Low Back Pain in Industry
van Poppel, M. N. M., Koes, B. W., van der Ploeg, T., Smid, T., & Bouter, L. M. (1998) · JAMA · doi:10.1001/jama.279.22.1789 · Cited by 143 · see citing works
Conservative treatment of acute low-back pain, a prospective randomized trial: McKenzie method of treatment versus patient education in mini-back school.
Solyom, C., & Hayes, B. (1991) · PubMed · Cited by 140 · see citing works
Evidence for the Role of Psychological Factors in Abnormal Paraspinal Activity in Patients with Chronic Low Back Pain
Watson, P. J., Booker, C. K., & Main, C. J. (1997) · Journal of Musculoskeletal Pain · doi:10.1300/j094v05n04_05 · Cited by 137 · see citing works
Conservative Treatment of Acute Low-Back Pain
Stankovic, R., & Johnell, O. (1990) · Spine · doi:10.1097/00007632-199002000-00014 · Cited by 136 · see citing works
A Controlled, Prospective Study to Evaluate the Effectiveness of a Back School in the Relief of Chronic Low Back Pain
Moffett, J. A. K., CHASE, S. M., Portek, I., & Ennis, J. (1986) · Spine · doi:10.1097/00007632-198603000-00003 · Cited by 134 · see citing works
The measurement of attitudes towards and beliefs about pain
Strong, J., Ashton, R., & Chant, D. C. (1992) · Pain · doi:10.1016/0304-3959(92)90062-g · Cited by 126 · see citing works
Group Education Interventions for People With Low Back Pain
Cohen, J. E., Goel, V., Frank, J. W., Bombardier, C., Peloso, P. M. J., & Guillemin, F. (1994) · Spine · doi:10.1097/00007632-199405310-00004 · Cited by 103 · see citing works
PSYCHOSOCIAL ISSUES
Gatchel, R. J., & Gardea, M. A. (1999) · Neurologic Clinics · doi:10.1016/s0733-8619(05)70119-5 · Cited by 91 · see citing works
Low Back Schools
LINTON, S. J., & Kamwendo, K. (1987) · Physical Therapy · doi:10.1093/ptj/67.9.1375 · Cited by 91 · see citing works
Cognitive-educational treatment of fibromyalgia: a randomized clinical trial. II. Economic evaluation.
Goossens, M. E. J. B., Mölken, M. R., Leidl, R., Bos, S., Vlaeyen, J. W. S., & Teeken-Gruben, N. J. (1996) · PubMed · Cited by 80 · see citing works
The effect of the Swedish Back School in chronic idiopathic low back pain. A prospective controlled study
Lankhorst, G. J., van de Stadt, R. J., Vogelaar, T. W., Korst, J. K. V. D., & Prevo, A. J. H. (2015) · Journal of Rehabilitation Medicine · doi:10.2340/16501977153141145 · Cited by 75 · see citing works
No Clinical Effect of Back Schools in an HMO A Randomized Prospective Trial
Berwick, D. M., Budman, S. H., & Feldstein, M. (1989) · Spine · doi:10.1097/00007632-198903000-00016 · Cited by 74 · see citing works
The Swedish back school in chronic low back pain. Part I. Benefits
Hurri, H. (2018) · Journal of Rehabilitation Medicine · doi:10.2340/165019771721033040 · Cited by 72 · see citing works
Psychosocial issues in the prevention of chronic low back pain—a literature review
Weiser, S. R., & Cedraschi, C. (1992) · Baillière s Clinical Rheumatology · doi:10.1016/s0950-3579(05)80132-3 · Cited by 69 · see citing works
The physical and psychological experience of pain: the effects of labeling and cold pressor temperature on three pain measures in college women
Hirsch, M. S., & Liebert, R. M. (1998) · Pain · doi:10.1016/s0304-3959(98)00080-3 · Cited by 69 · see citing works
Anthropometry, Spinal Canal Width, and Flexibility of the Spine and Hamstring Muscles in 45–55-Year-Old Men With and Without Low Back Pain
Hultman, G., Saraste, H., & Ohlsén, H. (1992) · Journal of Spinal Disorders · doi:10.1097/00002517-199209000-00001 · Cited by 69 · see citing works
Chronic pain in primary care. Identification and management of psychosocial factors.
Sullivan, M. D., Ja, T., & Romano, J. M. (1991) · PubMed · Cited by 64 · see citing works
Learning Effects of a Back Education Program
Schenk, R. J., Doran, R. L., & Stachura, J. J. (1996) · Spine · doi:10.1097/00007632-199610010-00001 · Cited by 61 · see citing works
Effect of physical training and ergonomic counselling on the psychological perception of work and on the subjective assessment of low-back insufficiency.
Dehlin, O., Berg, S., Gb, A., & Grimby, G. (1981) · PubMed · Cited by 59 · see citing works
Conceptual Issues in the Assessment of Clinical Pain
Turk, D. C., & Kerns, R. D. (1984) · The International Journal of Psychiatry in Medicine · doi:10.2190/rqar-ut6w-g4a0-tyhy · Cited by 48 · see citing works
Evaluation of an Advanced Back Pain Rehabilitation Program
Åberg, J. (1984) · Spine · doi:10.1097/00007632-198404000-00018 · Cited by 37 · see citing works
The Swedish Back School in Chronic Low Back Pain. Part II. Factors Predicting the Outcome
Hurri, H. (2020) · Journal of Rehabilitation Medicine · doi:10.2340/1650197789214144 · Cited by 36 · see citing works
Compliance for Low-Back Pain Patients in the Emergency Department
Jones, S. L., Jones, P. K., & Katz, J. (1988) · Spine · doi:10.1097/00007632-198805000-00020 · Cited by 21 · see citing works
The effect of the Swedish Back School in chronic idiopathic low back pain. A prospective controlled study
GJ, V. D. S. R. L. (1983) · Journal of Rehabilitation Medicine · doi:10.2340/16501977198315197203 · Cited by 15 · see citing works
The Swedish back school in chronic low back pain. Part I. Benefits
Hurri, H. (1989) · Journal of Rehabilitation Medicine · doi:10.2340/1650197719893340 · Cited by 13 · see citing works
The Swedish back school in chronic low back pain. Part II. Factors predicting the outcome
Hurri, H. (1989) · Journal of Rehabilitation Medicine · doi:10.2340/1650197719894144 · Cited by 7 · see citing works
Physiotherapy for patients with chronic pain: An operant-behavioural approach
Martinez, A., Simmonds, M. J., & Novy, D. M. (1997) · Physiotherapy Theory and Practice · doi:10.3109/09593989709036452 · Cited by 5 · see citing works

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van Middelkoop, M., Rubinstein, S. M., Kuijpers, T., Verhagen, A. P., Ostelo, R., Koes, B. W., & van Tulder, M. W. (2010) · European Spine Journal · doi:10.1007/s00586-010-1518-3 · Cited by 728 · see citing works
“After removing duplicates, 83 studies were included, comprising the following subjects: exercise therapy [14–50] (n = 37), back schools [51–55] (n = 5), TENS [56–61] (n = 6), low-level laser therapy [62–64] (n = 3), massage [65–67] (n = 3), behavioural treatment [68–88] (n = 21), patient education [89] (n = 1), tracti…”
Background
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Louw, A., Zimney, K. J., Puentedura, E. J., & Diener, I. (2016) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2016.1194646 · Cited by 738 · see citing works
“…Puentedura, 2014; Moseley, 2003c; Moseley, Nicholas, and Hodges, 2004; Pires, Cruz, and Caeiro, 2015; Téllez-García et al., 2014) ● Synapses (Moseley, 2003c; Moseley, Nicholas, and Hodges, 2004) ● Action potentials (Louw, Diener, Landers, and Puentedura, 2014) ● Spinal inhibition and facilitation…”
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Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2011.07.198 · Cited by 686 · see citing works
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Delitto, A., George, S. Z., Dillen, L. V., Whitman, J. M., Sowa, G., Shekelle, P., Denninger, T. R., & Godges, J. J. (2012) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2012.42.4.a1 · Cited by 1,166 · see citing works
Efficacy of classification‐based cognitive functional therapy in patients with non‐specific chronic low back pain: A randomized controlled trial
Fersum, K. V., O’Sullivan, P., Skouen, J. S., Smith, A. J., & Kvåle, A. (2012) · European Journal of Pain · doi:10.1002/j.1532-2149.2012.00252.x · Cited by 472 · see citing works
“The study was a RCT designed to evaluate the efficacy of the CB-CFT according to the system proposed by O’Sullivan (2005), as compared with MT-EX in patients with NSCLBP.”
ResultInfluential
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Moseley, G. L., & Flor, H. (2012) · Neurorehabilitation and neural repair · doi:10.1177/1545968311433209 · Cited by 454 · see citing works
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Watson, J. A., Ryan, C. G., Cooper, L., Ellington, D., Whittle, R., Lavender, M., Dixon, J., Atkinson, G., Cooper, K., & Martin, D. J. (2019) · The Journal of Pain · doi:10.1016/j.jpain.2019.02.011 · Cited by 428 · see citing works
How to explain central sensitization to patients with ‘unexplained’chronic musculoskeletal pain: Practice guidelines
Nijs, J., Paul van Wilgen, C., Van Oosterwijck, J., van Ittersum, M., & Meeus, M. (2011) · Manual Therapy · doi:10.1016/j.math.2011.04.005 · Cited by 390 · see citing works
“In patients with chronic low back pain, pain physiology education alters pain perceptions and, in conjunction with physiotherapy, it improves functional and symptomatic outcomes (Moseley, 2002; Moseley, 2003b; Moseley et al., 2004; Moseley, 2005).”
Background
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Moseley, G. L. (2007) · Physical Therapy Reviews · doi:10.1179/108331907x223010 · Cited by 334 · see citing works
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Engers, A. J., Jellema, P., Wensing, M., van der Windt, D., Grol, R. P. T. M., & van Tulder, M. W. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004057.pub3 · Cited by 301 · see citing works
A Mechanism-Based Approach to Physical Therapist Management of Pain
Chimenti, R. L., Frey-Law, L. A., & Sluka, K. A. (2018) · Physical Therapy · doi:10.1093/ptj/pzy030 · Cited by 300 · see citing works
A systematic review and meta‐analysis of pain neuroscience education for chronic low back pain: Short‐and long‐term outcomes of pain and disability
Wood, L., & Hendrick, P. A. (2019) · European Journal of Pain · doi:10.1002/ejp.1314 · Cited by 257 · see citing works
The 2013 EAU Guidelines on Chronic Pelvic Pain: Is Management of Chronic Pelvic Pain a Habit, a Philosophy, or a Science? 10 Years of Development
Engeler, D. S., Baranowski, A. P., Dinis, P., Elneil, S., Hughes, J. H., Messelink, E. J., van Ophoven, A., & Williams, A. C. D. C. (2013) · European Urology · doi:10.1016/j.eururo.2013.04.035 · Cited by 253 · see citing works
“There are no good published models of this practice yet, although there is evidence that effective education can mobilise patients to start to rehabilitate [39].”
Background
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“There is some evidence that pain neuroscience education (Moseley, 2004; Moseley et al., 2004; van Oosterwijck et al., 2011) may be an effective sole treatment for people with chronic musculoskeletal pain.”
Background
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“Educational programs explaining the neurophysiological mechanisms of pain have proven more effective than back schools (which emphasize end organ dysfunction and behavioural changes to decrease loading of anatomical structures) in CLBP patients [49-51,197].”
Background
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Louw, A., Diener, I., Landers, M. R., & Puentedura, E. J. (2014) · Spine · doi:10.1097/brs.0000000000000444 · Cited by 202 · see citing works
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Smart, K. M., Blake, C. M., Staines, A. S., Thacker, M. A., & Doody, C. (2012) · Manual Therapy · doi:10.1016/j.math.2012.03.013 · Cited by 193 · see citing works
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Background
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A Randomized-controlled Trial of Using a Book of Metaphors to Reconceptualize Pain and Decrease Catastrophizing in People With Chronic Pain
Gallagher, L. B., McAuley, J. H., & Moseley, G. L. (2012) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e3182465cf7 · Cited by 178 · see citing works
“We might instead predict that metaphor and story may be best utilized at the initial point of contact to loosen existing concepts, making them more amenable to change, and to pave the way for other more explicit interventions that are known to reduce pain levels and disability in people with chronic pain: for example…”
BackgroundSelf-citation
Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: A pilot study
Oosterwijck, J. V., Nijs, J., Meeus, M., Truijen, S., Craps, J., den Keybus, N. V., & Paul, L. (2011) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2009.12.0206 · Cited by 177 · see citing works
“Education about the neurophysiology of pain has been studied in chronic pain populations, such as chronic low back pain [27,29–32] and chronic fatigue syndrome [33].”
Background
Central sensitization, chronic pain, and other symptoms: Better understanding, better management
Volcheck, M. M., Graham, S. M., Fleming, K. C., Mohabbat, A. B., & Luedtke, C. A. (2023) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.90a.22019 · Cited by 186 · see citing works
Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: A pilot randomised controlled trial
Ryan, C. G., Gray, H., Newton, M., & Granat, M. H. (2010) · Manual Therapy · doi:10.1016/j.math.2010.03.003 · Cited by 174 · see citing works
“This form of intervention can decrease pain, pain related fear and behaviour, and increase self-reported function when provided alone or in conjunction with usual care physiotherapy (Moseley, 2002, 2004, 2005; Moseley et al., 2004).”
BackgroundInfluential
A prospective sequential analysis of the fear-avoidance model of pain
Wideman, T. H., Adams, H., & Sullivan, M. J. L. (2009) · Pain · doi:10.1016/j.pain.2009.04.022 · Cited by 162 · see citing works
“Additionally, alternate interventions such as education and exposure have been shown to lower the levels of catastrophizing [16,23,24].”
Background
Impact of biomedical and biopsychosocial training sessions on the attitudes, beliefs, and recommendations of health care providers about low back pain: A randomised clinical trial
Doménech, J., Zuriaga, D. S., Segura‐Ortí, E., Espejo, B., & Lisón, J. F. (2011) · Pain · doi:10.1016/j.pain.2011.07.023 · Cited by 162 · see citing works
“This finding is reminiscent of the reported worsening in pain beliefs observed in LBP patients after receiving information about anatomy and biomechanics of the spine [34].”
Result
Clinically Meaningful Scores on Pain Catastrophizing Before and After Multidisciplinary Rehabilitation: A Prospective Study of Individuals With Subacute Pain After Whiplash Injury
Scott, W., Wideman, T. H., & Sullivan, M. J. L. (2014) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e31828eee6c · Cited by 155 · see citing works
Neurophysiological Pain Education for Patients With Chronic Low Back Pain
Tegner, H., Frederiksen, P., Esbensen, B. A., & Juhl, C. B. (2018) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000594 · Cited by 154 · see citing works
“The difference in favor of NPE in reduction in Tampa Scale of Kinesiophobia was not statistically significant, WMD=−5.73 (95% CI, −13.60 to 2.14) and after 3 months WMD=−0.94 (95% CI, −6.28 to 4.40).”
MethodInfluential
Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain
Brox, J. I., Storheim, K., Grotle, M., Tveito, T. H., Indahl, A., & Eriksen, H. R. (2007) · The Spine Journal · doi:10.1016/j.spinee.2007.07.389 · Cited by 148 · see citing works
“We included 12 studies with 3,583 patients reported in 13 papers [6,22,50,52,54‐64], eight were of high quality (Table 2a, Table 2b) [6, 50 ,52,57,60,61,64].”
BackgroundMethodInfluential
From acute musculoskeletal pain to chronic widespread pain and fibromyalgia: Application of pain neurophysiology in manual therapy practice
Nijs, J., & Houdenhove, B. V. (2008) · Manual Therapy · doi:10.1016/j.math.2008.03.001 · Cited by 147 · see citing works
“Pain neurophysiology education aims at reconceptualising pain, and was found to be effective in reducing pain catastrophising in those with chronic low back pain (Moseley et al., 2004) and chronic widespread pain (Meeus et al.”
Background
Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain
Moseley, G. L. (2005) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(05)70053-2 · Cited by 142 · see citing works
Self-citation
Effects of education to facilitate knowledge about chronic pain for adults: a systematic review with meta-analysis
Geneen, L. J., Martin, D. J., Adams, N., Clarke, C., Dunbar, M., Jones, D., McNamee, P., Schofield, P., & Smith, B. H. (2015) · Systematic Reviews · doi:10.1186/s13643-015-0120-5 · Cited by 129 · see citing works
“Nine studies were included (Ferrell et al. 1997 [17], Gallagher et al. 2013 [18]; Linton et al. 1997 [11], Morrison et al. 1988 [12], Moseley et al. 2004 [19], PAIN INTENSITY Education versus usual care “average pain” Soares 2002; Ruehlman 2013 18 17 35 SMD random 0 0.02 [−0.19, 0.24] 0.21 0.83…”
BackgroundMethodInfluential
Psychologically Informed Interventions for Low Back Pain: An Update for Physical Therapists
Nicholas, M. K., & George, S. Z. (2011) · Physical Therapy · doi:10.2522/ptj.20100278 · Cited by 139 · see citing works
Self-citation
Is adherence to pain self‐management strategies associated with improved pain, depression and disability in those with disabling chronic pain?
Nicholas, M. K., Asghari̇, A., Corbett, M., Smeets, R., Wood, B. M., Overton, S., Perry, C. J., Tonkin, L., & Beeston, L. (2011) · European Journal of Pain · doi:10.1016/j.ejpain.2011.06.005 · Cited by 135 · see citing works
Self-citation
Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey
Karayannis, N. V., Jull, G. A., & Hodges, P. W. (2012) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-13-24 · Cited by 134 · see citing works
“In addition to the biomechanical system influences on LBP, psychosocial and neurophysiologic systems are equally important to consider in a multidimensional LBP assessment model [107-109].”
BackgroundSelf-citation
Adverse effects of COVID-19-related lockdown on pain, physical activity and psychological well-being in people with chronic pain
Fallon, N. B., Brown, C. A., Twiddy, H., Brian, E., Frank, B., Nurmikko, T. J., & Stančák, A. (2020) · British Journal of Pain · doi:10.1177/2049463720973703 · Cited by 135 · see citing works
“Remote technologies also have the potential to deliver pain physiology education, which are effective in alleviating pain catastrophizing [34; 36].”
Background
Preoperative education addressing postoperative pain in total joint arthroplasty: Review of content and educational delivery methods
Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2012) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2012.727527 · Cited by 133 · see citing works
“…pain (Louw, Louw, and Crous, 2009) and recent studies in non-surgical orthopedic patients with chronic low back pain (LBP) (Moseley, 2002, 2004; Moseley, Hodges, and Nicholas, 2004) and whiplash associated disorders (Van Oosterwijck et al, 2011) have shown that patients are able to understand…”
Background
Mechanosensitivity of the Lower Extremity Nervous System During Straight-Leg Raise Neurodynamic Testing in Healthy Individuals
Boyd, B. S., Wanek, L. J., Gray, A. T., & Topp, K. S. (2009) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2009.3002 · Cited by 132 · see citing works
Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: a randomized controlled trial
Pires, D., Cruz, E. B., & Caeiro, C. (2014) · Clinical Rehabilitation · doi:10.1177/0269215514549033 · Cited by 129 · see citing works
Multi-disciplinary interventions for chronic pain involving education: a systematic review
Joypaul, S., Kelly, F., McMillan, S. S., & King, M. A. (2019) · PLOS ONE · doi:10.1371/journal.pone.0223306 · Cited by 119 · see citing works
The clinical application of teaching people about pain
Louw, A., Zimney, K. J., O’Hotto, C., & Hilton, S. (2016) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2016.1194652 · Cited by 123 · see citing works
Fear-avoidance beliefs and clinical outcomes for patients seeking outpatient physical therapy for musculoskeletal pain conditions
George, S. Z., & Stryker, S. E. (2011) · Journal of Orthopaedic & Sports Physical Therapy · doi:10.2519/jospt.2011.3488 · Cited by 118 · see citing works
Neuroplasticity of Sensorimotor Control in Low Back Pain
Brumagne, S., Diers, M., Danneels, L. A., Moseley, G. L., & Hodges, P. W. (2019) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2019.8489 · Cited by 118 · see citing works
Self-citation
Postural awareness and its relation to pain: validation of an innovative instrument measuring awareness of body posture in patients with chronic pain
Cramer, H., Mehling, W., Saha, F. J., Dobos, G., & Lauche, R. (2018) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-018-2031-9 · Cited by 107 · see citing works
Comparison of Mulligan Sustained Natural Apophyseal Glides and Maitland Mobilizations for Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial
Reid, S. A., Rivett, D. A., Katekar, M. G., & Callister, R. (2013) · Physical Therapy · doi:10.2522/ptj.20120483 · Cited by 111 · see citing works
A clinical perspective on a pain neuroscience education approach to manual therapy
Louw, A., Nijs, J., & Puentedura, E. J. (2017) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2017.1323699 · Cited by 122 · see citing works
“PNE, by its definition, is an educational intervention aiming to alter a patient’s beliefs and cognitions regarding their pain experience [13,20,22].”
Background
Is reduction in pain catastrophizing a therapeutic mechanism specific to cognitive-behavioral therapy for chronic pain?
Burns, J. W., Day, M. A., & Thorn, B. E. (2012) · Translational Behavioral Medicine · doi:10.1007/s13142-011-0086-3 · Cited by 112 · see citing works
“” Notable exceptions include studies in which the educational intervention is based on the biopsychosocial model rather than a biomedical model [35, 40–42], which was the case in this RCT.”
Background
Illness perceptions in patients with fibromyalgia and their relationship to quality of life and catastrophizing
van Wilgen, C. P., van Ittersum, M. W., Kaptein, A. A., & van Wijhe, M. (2008) · Arthritis & Rheumatism · doi:10.1002/art.23959 · Cited by 112 · see citing works
Combined education and patient-led goal setting intervention reduced chronic low back pain disability and intensity at 12 months: a randomised controlled trial
Gardner, T., Refshauge, K. M., McAuley, J. H., Hübscher, M., Goodall, S., & Smith, L. D. (2019) · British Journal of Sports Medicine · doi:10.1136/bjsports-2018-100080 · Cited by 104 · see citing works
Differential predictors of the long-term levels of pain intensity, work disability, healthcare use, and medication use in a sample of workers' compensation claimants
Wideman, T. H., & Sullivan, M. J. L. (2011) · Pain · doi:10.1016/j.pain.2010.10.044 · Cited by 102 · see citing works
“Previous research suggests that a wide range of interventions can lead to reductions in pain catastrophizing [20,21,29,33].”
Orthopaedic manual therapy, McKenzie method or advice only for low back pain in working adults: A randomized controlled trial with one year follow-up
Paatelma, M., Kilpikoski, S., Simonen, R. L., Heinonen, A. O., Alén, M., & Videman, T. (2008) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-0262 · Cited by 102 · see citing works
Combining manual therapy with pain neuroscience education in the treatment of chronic low back pain: A narrative review of the literature
Puentedura, E. J., & Flynn, T. W. (2016) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2016.1194663 · Cited by 101 · see citing works
“…PNE in patients with chronic pain in terms of reduced pain, pain catastrophization, disability, and improved physical performance (Clarke, Ryan, and Martin, 2011; Louw, Diener, Butler, and Puentedura, 2011; Moseley, 2002; Moseley, 2003a; Moseley, 2003b; Moseley, Nicholas, and Hodges, 2004).”
Background
Evidence-Based Psychological Interventions for the Management of Pediatric Chronic Pain: New Directions in Research and Clinical Practice
Coakley, R., & Wihak, T. (2017) · Children · doi:10.3390/children4020009 · Cited by 100 · see citing works
Blended-learning pain neuroscience education for people with chronic spinal pain: Randomized controlled multicenter trial
Malfliet, A., Kregel, J., Meeus, M., Roussel, N., Danneels, L., Cagnie, B., Dolphens, M., & Nijs, J. (2018) · Physical Therapy · doi:10.1093/ptj/pzx092 · Cited by 100 · see citing works
Short-term effect on pain and function of neurophysiological education and sensorimotor retraining compared to usual physiotherapy in patients with chronic or recurrent non-specific low back pain, a pilot randomized controlled trial
Wälti, P., Kool, J., & Luomajoki, H. A. (2015) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-015-0533-2 · Cited by 101 · see citing works
“Various research groups have demonstrated the potential value of focusing on abnormal cortical processing of the central nervous system (CNS) in patients with nonspecific chronic low back pain (NSCLBP) [7-14]: abnormal cortical processing includes cognitive, sensory and motor disturbances.”
Integrating Motivational Interviewing in Pain Neuroscience Education for People With Chronic Pain: A Practical Guide for Clinicians
Nijs, J., Wijma, A. J., Willaert, W., Huysmans, E., Mintken, P., Smeets, R., Goossens, M., van Wilgen, C. P., Van Bogaert, W., Louw, A., et al. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa021 · Cited by 97 · see citing works
Placebo analgesia: Clinical applications
Klinger, R., Colloca, L., Bingel, U., & Flor, H. (2013) · Pain · doi:10.1016/j.pain.2013.12.007 · Cited by 98 · see citing works
“Such an educational informative approach ought to explain the placebo effect based on the models of classical conditioning and expectancy, but also its neurobiological bases, without overstraining the patient [31] (eg, the therapist can inform about pharmacological and psychological effects of analgesics, emphasize le…”
Background
2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV
Bruce, R. D., Merlin, J. S., Lum, P. J., Ahmed, E., Alexander, C. S., Corbett, A., Foley, K. M., Leonard, K., Treisman, G. J., & Selwyn, P. A. (2017) · Clinical Infectious Diseases · doi:10.1093/cid/cix636 · Cited by 93 · see citing works
“However, the sample size was small and the patients were not identified as having HIV [81].”
Background
The Sensitization Model to Explain How Chronic Pain Exists Without Tissue Damage
van Wilgen, C. P., & Keizer, D. (2010) · Pain Management Nursing · doi:10.1016/j.pmn.2010.03.001 · Cited by 91 · see citing works
Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?
Lee, H., McAuley, J. H., Hübscher, M., Kamper, S. J., Traeger, A. C., & Moseley, G. L. (2016) · Pain · doi:10.1097/j.pain.0000000000000472 · Cited by 87 · see citing works
“The following constructs were identified as potential confounders of the indirect, direct, and total effects: pain duration (months), diagnosis, patients’ expectation of outcome (11-point numeric rating scale), and patients’ perception of the clinician (empathy, attentiveness, and expertise–each rated on an 11-point n…”
BackgroundMethodSelf-citation
Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies
Moseley, G. L., Leake, H. B., Beetsma, A. J., Watson, J. A., Butler, D. S., van der Mee, A., Stinson, J., Harvie, D. S., Palermo, T. M., Meeus, M., et al. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.11.008 · Cited by 86 · see citing works
Self-citation
Preoperative pain catastrophizing and postoperative pain after total knee arthroplasty: a prospective cohort study with one year follow-up
Høvik, L. H., Winther, S. B., Foss, O. A., & Gjeilo, K. H. (2016) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-016-1073-0 · Cited by 86 · see citing works
“Psychological and psychosocial interventions [49], education and instruction in self-management skills [50] or exercise and physical therapy [51, 52] were shown to be effective in reducing pain catastrophizing to some degree.”
Background
The Current State of Physical Therapy Pain Curricula in the United States: A Faculty Survey
Bement, M. H., & Sluka, K. A. (2014) · Journal of Pain · doi:10.1016/j.jpain.2014.11.001 · Cited by 82 · see citing works
“Further, there is a strong body of literature supporting the use of exercise for almost all pain conditions(23) and a growing body of literature showing the effectiveness of education of the patient on the science of pain, providing support for the incorporation of these concepts in PT pain curricula.(19,24,26,34) Fur…”
Background
Written pain neuroscience education in fibromyalgia: a multicenter randomized controlled trial
van Ittersum, M. W., van Wilgen, C. P., van der Schans, C. P., Lambrecht, L., Groothoff, J. W., & Nijs, J. (2014) · Pain Practice · doi:10.1111/papr.12137 · Cited by 79 · see citing works
A neuroscience approach to managing athletes with low back pain
Puentedura, E. J., & Louw, A. (2011) · Physical Therapy in Sport · doi:10.1016/j.ptsp.2011.12.001 · Cited by 79 · see citing works
Hybrid Approach to Treatment Tailoring for Low Back Pain: A Proposed Model of Care
Hodges, P. W. (2019) · Journal of Orthopaedic and Sports Physical Therapy · doi:10.2519/jospt.2019.8774 · Cited by 76 · see citing works
Self-citation
Pragmatic Implementation of a Stratified Primary Care Model for Low Back Pain Management in Outpatient Physical Therapy Settings: Two-Phase, Sequential Preliminary Study
Beneciuk, J. M., & George, S. Z. (2015) · Physical Therapy · doi:10.2522/ptj.20140418 · Cited by 76 · see citing works
Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic injury
Giummarra, M. J., Casey, S. L., Devlin, A. L., Ioannou, L., Gibson, S. J., Georgiou‐Karistianis, N., Jennings, P., Cameron, P. A., & Ponsford, J. (2017) · PAIN Reports · doi:10.1097/pr9.0000000000000622 · Cited by 75 · see citing works
Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?
Nijs, J., Oosterwijck, J. V., & Hertogh, W. D. (2009) · Clinical Rheumatology · doi:10.1007/s10067-008-1083-x · Cited by 73 · see citing works
“Pain physiology education was found to be effective in reducing pain catastrophizing in those with chronic low back pain [63, 64].”
Background
Listening is therapy: Patient interviewing from a pain science perspective
Diener, I., (6366965), M. K., & Louw, A. (2016) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2016.1194648 · Cited by 74 · see citing works
“…associated with the utilization of TNE have focused on a variety of disorders including: chronic low back pain (Moseley, 2002; Moseley, 2004; Moseley, Nicholas, and Hodges, 2004); lumbar surgery (Louw, Diener, Landers, and Puentedura, 2014; Puentedura et al, 2009); whiplash associated…”
Pain neuroscience education combined with therapeutic exercises provides added benefit in the treatment of chronic neck pain
Javdaneh, N., Saeterbakken, A. H., Shams, A., & Barati, A. H. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168848 · Cited by 71 · see citing works
“One of the essential aims of pain neuroscience education intervention is to alter patients’ beliefs and cognitions regarding their pain experience [50].”
Background
Physical and psychological aspects of whiplash: Important considerations for primary care assessment
Sterling, M. M., & Kenardy, J. A. (2008) · Manual Therapy · doi:10.1016/j.math.2007.11.003 · Cited by 70 · see citing works
“Cognitive approaches including education in various forms have been shown to be effective in reducing pain and disability in whiplash (Oliveira et al., 2006) as well as influencing pain cognitions in low back pain (Moseley et al., 2004).”
Background
An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up
Sørensen, P. H., Bendix, T., Manniche, C., Korsholm, L., Lemvigh, D., & Indahl, A. (2010) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-11-212 · Cited by 70 · see citing works
“Cognitive theories include elements of central pain perception as well as optimisation of peripheral muscular control[14-23].”
Background
A qualitative exploration of people's experiences of pain neurophysiological education for chronic pain: The importance of relevance for the individual
Robinson, V., King, R., Ryan, C. G., & Martin, D. J. (2016) · Manual Therapy · doi:10.1016/j.math.2015.10.001 · Cited by 69 · see citing works
A systematic review of cross‐cultural validation of the pain catastrophizing scale
Ikemoto, T., Hayashi, K., Shiro, Y., Arai, Y.-C. P., Marcuzzi, A., Costa, D. S. J., & Wrigley, P. J. (2020) · European Journal of Pain · doi:10.1002/ejp.1587 · Cited by 70 · see citing works
Pain Reconceptualisation after Pain Neurophysiology Education in Adults with Chronic Low Back Pain: A Qualitative Study
King, R., Robinson, V., Elliott-Button, H. L., Watson, J. A., Ryan, C. G., & Martin, D. (2018) · Pain Research and Management · doi:10.1155/2018/3745651 · Cited by 69 · see citing works
Is the biopsychosocial model in musculoskeletal physiotherapy adequate? An evolutionary concept analysis
Daluiso-King, G., & Hebron, C. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2020.1765440 · Cited by 68 · see citing works
“…bio-psycho-social factors can be found to positively impact upon health outcomes, drawing healthcare further away from the BMM (Lumley et al., 2011; Moseley, Nicholas, and Hodges, 2004) toward the alternative BPSM, where the values of humanism2 and scientism3 are proposedly intertwined (Brosschot,…”
Background
The relationship between knowledge of pain neurophysiology and fear avoidance in people with chronic pain: A point in time, observational study
Fletcher, C., Bradnam, L. V., & Barr, C. (2016) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2015.1138010 · Cited by 66 · see citing works
“However, Moseley, Nicholas, and Hodges (2004) reported that specific PNE training in people with chronic pain yielded a mean rNPQ score of around 60% and our mean of the rNPQ score was 55% (range 23–84%).”
BackgroundMethodResultInfluential
The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial
Saraçoğlu, İ., Arık, M. I., Afşar, E., & Gökpınar, H. H. (2020) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2020.1809046 · Cited by 66 · see citing works
“Several studies evaluating the efficacy of PNE in CLBP showed that PNE combined with MT and exercise had favorable statistical effects on levels of pain and disability (Moseley, 2002; Moseley, Nicholas, and Hodges, 2004; Nijs et al., 2014).”
Background
Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy
Louw, A., Butler, D. S., Diener, I., & Puentedura, E. J. (2013) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3182876aa4 · Cited by 63 · see citing works
“nervous system and the brain’s processing of pain and nociceptive input.(34,43) This approach is in direct”
BackgroundMethodInfluential
An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Physical Therapy
Bement, M. H., Marie, B. S., Nordstrom, T. M., Christensen, N., Mongoven, J. M., Koebner, I. J., Fishman, S. M., & Sluka, K. A. (2013) · Physical Therapy · doi:10.2522/ptj.20130346 · Cited by 63 · see citing works
Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion
Louw, A., Puentedura, E. J., Reese, D., Parker, P., Miller, T., & Mintken, P. E. (2017) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2017.03.031 · Cited by 63 · see citing works
How Much Is Needed? Comparison of the Effectiveness of Different Pain Education Dosages in Patients with Fibromyalgia
Amer-Cuenca, J. J., Pecos‐Martín, D., Martínez‐Merinero, P., Girbés, E. L., Nijs, J., Meeus, M., Peña, R. F., & Fernández‐Carnero, J. (2019) · Pain Medicine · doi:10.1093/pm/pnz069 · Cited by 62 · see citing works
Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review
Barbari, V., Storari, L., Ciuro, A., & Testa, M. (2019) · Patient Education and Counseling · doi:10.1016/j.pec.2019.11.031 · Cited by 66 · see citing works
An Interprofessional Consensus of Core Competencies for Prelicensure Education in Pain Management: Curriculum Application for Nursing
Herr, K., Marie, B. S., Gordon, D. B., Paice, J. A., Watt‐Watson, J., Stevens, B., Bakerjian, D., & Young, H. M. (2015) · Journal of Nursing Education · doi:10.3928/01484834-20150515-02 · Cited by 62 · see citing works
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
Sharma, S., Jensen, M. P., Moseley, G. L., & Abbott, J. H. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026874 · Cited by 61 · see citing works
Self-citation
Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy
Louw, A., Diener, I., Landers, M. R., Zimney, K., & Puentedura, E. J. (2016) · Journal of Spine Surgery · doi:10.21037/jss.2016.12.04 · Cited by 59 · see citing works
“Various randomized controlled trials (RCT) and a systematic review have shown that PNE has a positive effect on pain, disability, pain catastrophization, and physical movement for patients with chronic low back pain (CLBP), extending to 1-year outcomes (22-26).”
Background
The Comfort Ability Pain Management Workshop: A Preliminary, Nonrandomized Investigation of a Brief, Cognitive, Biobehavioral, and Parent Training Intervention for Pediatric Chronic Pain
Coakley, R., Wihak, T., Kossowsky, J., Iversen, C., & Donado, C. (2018) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsx112 · Cited by 59 · see citing works
An abbreviated therapeutic neuroscience education session improves pain knowledge in first-year physical therapy students but does not change attitudes or beliefs
Cox, T., Louw, A., & Puentedura, E. J. (2016) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2015.1122308 · Cited by 62 · see citing works
Efficacy of classification-specific treatment and adherence on outcomes in people with chronic low back pain. A one-year follow-up, prospective, randomized, controlled clinical trial
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Authors: Moseley, G. L., Nicholas, M. K., & Hodges, P. W.
Affiliations: The University of Sydney (AU)
Corresponding author: Moseley, G. Lorimer
Hodges, Paul W.
ORCID: Moseley, G. Lorimer
Nicholas, Michael K.
Hodges, Paul W.
Venue: The Clinical Journal of Pain
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2004
Volume: 20
Issue: 5
Pages: 324-330
ISSN: 0749-8047 (ISSN-L)
DOI: 10.1097/00002508-200409000-00007
OpenAlex: W2078673653
Cited by: 537
References: 50
Citations by year: 2026: 16 · 2025: 23 · 2024: 36 · 2023: 32 · 2022: 24 · 2021: 50 · 2020: 45 · 2019: 31 · 2018: 34 · 2017: 31 · 2016: 40 · 2015: 34 · 2014: 18 · 2013: 20 · 2012: 16
FWCI: 2.30
Type: journal article
Language: en
Open access: closed
Locations: Clinical Journal of Pain (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 › Medicine › Physiology › Pain Mechanisms and Treatments
Keywords: neurophysiology education, chronic low back pain, pain-related cognitions, pain catastrophizing, pain attitudes, disability, physical performance, cognitive-behavioral pain management, physiotherapy education
MeSH terms: Adult, Analysis of Variance, Chronic Disease, Double-Blind Method, Female, Humans, Male, Middle Aged, Neurophysiology, Pain Measurement, Patient Education as Topic, Psychomotor Performance, Surveys and Questionnaires, Cognitive Behavioral Therapy, Low Back Pain

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A Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain

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