Pain Neuroscience Education (PNE)

Pain Neuroscience Education (PNE) is an approach that emerged in the early 2000s that aims to improve patient outcomes by improving a patient's understanding of pain. The goal is to lower fear and catastrophization by aiding the patient in re-conceptualizing the pain experience. Tools used in this approach include explaining the complex biological and psychological processes that contribute to the pain experience, shifting the focus from a purely biomedical perspective to a biopsychosocial (BPS) perspective, as well as the use of various stories, metaphors, and analogies to aid in understanding.

• Effectiveness Based on Research: Unfortunately, peer-reviewed and published comparative research has demonstrated that PNE is a relatively ineffective methodology. This may be due in part to the relatively small effect narratives, expectations, and beliefs have on the effectiveness of other more effective modalities for treating orthopedic pain (e.g., manual therapy, specific exercise, and some modalities).

Additional Terms:

• Pain Science
• Biopsychosocial (BPS) model

For more information (including systematic research reviews):

• Pain Neuroscience Education (PNE) is Relatively Ineffective: Research Confirmed
• False Narratives, Nocebo, and Negative Expectations do NOT affect Manual Therapy Outcomes: Research Confirmed

Research Summary Statement from the Article Above:

The randomized controlled trials (RCTs) available that compare pain neuroscience education (PNE) to other interventions imply that PNE is unlikely to be more effective than biomedical education, and is unlikely to result in additional benefit when added to supervised manual therapy, exercise, and/or the combination of other effective interventions. Further, the addition of manual therapy and exercise to PNE reliably results in significant improvement in patient outcomes, implying that PNE alone cannot be considered an optimal treatment approach. The addition of PNE to a home exercise program may enhance patient outcomes (perhaps due to enhanced effort and compliance during exercise). Last, PNE does reliably improve Tampa Scale of Kinesiophobia (TSK) scores; however, the validity of this finding and/or correlation with other recovery outcome measures is questionable.

• Of the 10 studies in this review comparing similar intervention plans with and without PNE, 4 studies demonstrate no difference, 3 studies only demonstrate a significant difference in TSK scores, and 3 studies exhibit significant improvements in 1 additional outcome measure. Unfortunately, the additional outcome measures are likely statistical variance. These additional outcome measures are either easily influenced by subjective or cognitive factors (FABQ and Pain), represent a difference in one outcome with other similar outcomes not demonstrating difference, and/or the difference was only demonstrated during one of the multiple time points. In short, the gross majority of comparative research demonstrates that PNE is not reliably effective for improving objective patient outcome measures.