{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T03:13:55Z","timestamp":1794280435447,"version":"4.9.0"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T00:00:00Z","timestamp":1700784000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In recent years, pain neuroscience education (PNE) has been the focus of extensive research in the scientific literature in the field of physical therapy, but the results obtained are controversial and its clinical application remains unclear. The main aim of this umbrella review was to assess the effectiveness of PNE in patients with chronic musculoskeletal pain (CMP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched systematically in PubMed (Medline), PEDro, EMBASE, CINAHL and PsycINFO. Methodological quality was analyzed using AMSTAR-2 scale and overlapping analysis using GROOVE tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>16 systematic reviews were included. A qualitative synthesis was performed for the following sets of patients with CMP: overall CMP, chronic spinal pain, patients with fibromyalgia and patients with osteoarthritis. In general terms, it seems that the addition of the PNE-based intervention to other treatments, mostly exercise-based interventions although we might refer to it in terms of a multimodal approach, leads to greater clinical improvements than the multimodal approach alone. We have found this especially in the reduction of the influence of psychosocial variables. However, it seems that studies testing the effectiveness of PNE in isolation, systematic reviews with or without meta-analysis did not show statistically significant improvements overall in terms of pain intensity, disability levels or psychosocial variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>There is a great heterogeneity in the results obtained and the PNE protocols used, a critically low quality in the reviews included and a very high overlap, so there is a need to improve the studies in this field before clinical application.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>PROSPERO (CRD42022355634).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnins.2023.1272068","type":"journal-article","created":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T03:15:50Z","timestamp":1700795750000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":45,"title":["Pain neuroscience education in patients with chronic musculoskeletal pain: an umbrella review"],"prefix":"10.3389","volume":"17","author":[{"given":"Ferran","family":"Cuenca-Mart\u00ednez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Suso-Mart\u00ed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joaqu\u00edn","family":"Calatayud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Jos\u00e9","family":"Ferrer-Sargues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicente","family":"Mu\u00f1oz-Alarcos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricio","family":"Alba-Quesada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Bivi\u00e1-Roig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e12125","DOI":"10.1111\/JABR.12125","article-title":"Central sensitization and the biopsychosocial approach to understanding pain","volume":"23","author":"Adams","year":"2018","journal-title":"J. Appl. Biobehav. Res."},{"key":"ref2","unstructured":"ApkarianA.\n            BalikiM.\n          2009"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1016\/j.pec.2019.11.031","article-title":"Effectiveness of communicative and educative strategies in chronic low back pain patients: a systematic review","volume":"103","author":"Barbari","year":"2020","journal-title":"Patient Educ. Couns."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"511","DOI":"10.3233\/BMR-200091","article-title":"Applicability of pain neuroscience education: where are we now?","volume":"34","author":"Barbari","year":"2021","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"529","DOI":"10.2519\/jospt.2008.2861","article-title":"Evaluation of the scope and quality of systematic reviews on nonpharmacological conservative treatment for patellofemoral pain syndrome","volume":"38","author":"Barton","year":"2008","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1016\/J.JPAIN.2021.09.006","article-title":"Pain science education plus exercise therapy in chronic nonspecific spinal pain: a systematic review and Meta-analyses of randomized clinical trials","volume":"23","author":"Bonatesta","year":"2021","journal-title":"J. Pain"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.jclinepi.2017.10.002","article-title":"Preferred reporting items for overviews of systematic reviews including harms checklist: a pilot tool to be used for balanced reporting of benefits and harms","volume":"93","author":"Bougioukas","year":"2018","journal-title":"J. Clin. Epidemiol."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/J.EJPAIN.2005.06.009","article-title":"Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment","volume":"10","author":"Breivik","year":"2006","journal-title":"Eur. J. Pain"},{"key":"ref9","volume-title":"The British pain society participant information for pain management Programmes","year":"2013"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1093\/pm\/pnaa484","article-title":"Effectiveness of pain neurophysiology education on musculoskeletal pain: a systematic review and meta-analysis","volume":"22","author":"B\u00fclow","year":"2021","journal-title":"Pain Med."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"544","DOI":"10.1016\/j.math.2011.05.003","article-title":"Pain neurophysiology education for the management of individuals with chronic low back pain: a systematic review and meta-analysis","volume":"16","author":"Clarke","year":"2011","journal-title":"Man. Ther."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.33588\/rn.6501.2016561","article-title":"Efectividad de la educaci\u00f3n basada en neurociencia en el abordaje del dolor cr\u00f3nico musculoesquel\u00e9tico","volume":"65","author":"Cuenda-gago","year":"2017","journal-title":"Cr\u00f3nico"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"T70","DOI":"10.1016\/J.JPAIN.2016.01.001","article-title":"The role of psychosocial processes in the development and maintenance of chronic pain","volume":"17","author":"Edwards","year":"2016","journal-title":"J. Pain"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"49","DOI":"10.33588\/rn.6202.2015446","article-title":"Educaci\u00f3n al paciente con fibromialgia","volume":"62","author":"Elizagaray-garc\u00eda","year":"2016","journal-title":"Rev. Neurol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"CD004057","DOI":"10.1002\/14651858.CD004057.PUB3","article-title":"Individual patient education for low back pain","volume":"2008","author":"Engers","year":"2008","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0273667","DOI":"10.1371\/JOURNAL.PONE.0273667","article-title":"Cost analysis of chronic pain due to musculoskeletal disorders in Chile","volume":"17","author":"Espinoza","year":"2022","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/J.APMR.2020.06.019","article-title":"Effectiveness of exercise on fatigue and sleep quality in fibromyalgia: a systematic review and Meta-analysis of randomized trials","volume":"102","author":"Est\u00e9vez-L\u00f3pez","year":"2021","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"301","DOI":"10.23736\/S1973-9087.19.05524-2","article-title":"Effectiveness of health education in patients with fibromyalgia: a systematic review","volume":"55","author":"Garc\u00eda-R\u00edos","year":"2019","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1186\/1471-2458-11-770","article-title":"Pain as a global public health priority","volume":"11","author":"Goldberg","year":"2011","journal-title":"BMC Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1038\/NRRHEUM.2010.107","article-title":"Assessment of mechanisms in localized and widespread musculoskeletal pain","volume":"6","author":"Graven-Nielsen","year":"2010","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"765","DOI":"10.7326\/0003-4819-142-9-200505030-00013","article-title":"Meta-analysis: exercise therapy for nonspecific low Back pain","author":"Hayden","year":"2005","journal-title":"Ann. Intern. Med."},{"key":"ref12","author":"Higgins","year":"2023"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1111\/1468-0009.12210","article-title":"The mass production of redundant, misleading, and conflicted systematic reviews and meta-analyses","volume":"94","author":"Ioannidis","year":"2016","journal-title":"Milbank Q."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.jpain.2004.02.576","article-title":"Psychological aspects of persistent pain: current state of the science","volume":"5","author":"Keefe","year":"2004","journal-title":"J. Pain"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"309","DOI":"10.14474\/ptrs.2020.9.4.309","article-title":"Effects of pain neuroscience education on kinesiophobia in patients with chronic pain: a systematic review and meta-analysis","volume":"9","author":"Kim","year":"2020","journal-title":"Phys. Ther. Rehabil. Sci."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"922","DOI":"10.1097\/J.PAIN.0000000000000472","article-title":"Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?","volume":"157","author":"Lee","year":"2016","journal-title":"Pain"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"2041","DOI":"10.1016\/j.apmr.2011.07.198","article-title":"The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain","volume":"92","author":"Louw","year":"2011","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref28","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1080\/09593985.2016.1194646","article-title":"The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature","volume":"32","author":"Louw","year":"2016","journal-title":"Physiother. Theory Pract."},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/S12874-021-01269-Y\/FIGURES\/4","article-title":"Managing overlap of primary study results across systematic reviews: practical considerations for authors of overviews of reviews","volume":"21","author":"Lunny","year":"2021","journal-title":"BMC Med. Res. Methodol."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1080\/09593985.2019.1633714","article-title":"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","volume":"37","author":"Marris","year":"2021","journal-title":"Physiother. Theory Pract."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"276","DOI":"10.11613\/bm.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"22","author":"McHugh","year":"2012","journal-title":"Biochem. Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1016\/S0140-6736(98)01085-X","article-title":"Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?","volume":"352","author":"Moher","year":"1998","journal-title":"Lancet"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1179\/108331907X223010","article-title":"Reconceptualising pain according to modern pain science","volume":"12","author":"Moseley","year":"2013","journal-title":"Physical Therapy Reviews"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"807","DOI":"10.1016\/J.JPAIN.2015.05.005","article-title":"Fifteen years of explaining pain: the past, present, and future","volume":"16","author":"Moseley","year":"2015","journal-title":"J. Pain"},{"key":"ref35","unstructured":"NijsJ.\n            ClarkJ.\n            MalflietA.\n            IckmansK.\n          2017"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/J.MATH.2011.04.005","article-title":"How to explain central sensitization to patients with \u201cunexplained\u201d chronic musculoskeletal pain: practice guidelines","volume":"16","author":"Nijs","year":"2011","journal-title":"Man. Ther."},{"key":"ref37","doi-asserted-by":"publisher","first-page":"2559","DOI":"10.3390\/ijerph19052559","article-title":"Effectiveness of interventions based on pain neuroscience education on pain and psychosocial variables for osteoarthritis: a systematic review","volume":"19","author":"Ordo\u00f1ez-Mora","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1002\/JRSM.1557","article-title":"Graphical representation of overlap for OVErviews: GROOVE tool","volume":"13","author":"P\u00e9rez-Bracchiglione","year":"2022","journal-title":"Res. Synth. Methods"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/J.MATH.2015.10.001","article-title":"A qualitative exploration of people\u2019s experiences of pain neurophysiological education for chronic pain: the importance of relevance for the individual","volume":"22","author":"Robinson","year":"2016","journal-title":"Man. Ther."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1111\/PAPR.12962","article-title":"A meta-analysis of therapeutic pain neuroscience education, using dosage and treatment format as moderator variables","volume":"21","author":"Romm","year":"2021","journal-title":"Pain Pract."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/21679169.2022.2162962","article-title":"Effects of pain neuroscience education on psycho-emotional and cognitive variables in individuals with chronic musculoskeletal pain: a systematic review of randomised clinical trials","author":"Salazar-M\u00e9ndez","year":"2023","journal-title":"Eur. J. Phys."},{"key":"ref42","doi-asserted-by":"publisher","first-page":"105328","DOI":"10.1016\/J.NEUBIOREV.2023.105328","article-title":"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","volume":"153","author":"Salazar-M\u00e9ndez","year":"2023","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1111\/1756-185X.14293","article-title":"Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: a systematic review and meta-analysis","volume":"25","author":"Saracoglu","year":"2022","journal-title":"Int. J. Rheum. Dis."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1155","DOI":"10.1177\/0269215515570379","article-title":"Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials","volume":"29","author":"Searle","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"E20","DOI":"10.1097\/j.pain.0000000000002308","article-title":"Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: a systematic review and meta-analysis","volume":"163","author":"Siddall","year":"2022","journal-title":"Pain"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2017\/2356346","article-title":"Effectiveness of therapeutic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomized clinical trials","volume":"2017","author":"Sosa-Reina","year":"2017","journal-title":"Biomed. Res. Int."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1053\/apnr.2002.34181","article-title":"Popping the (PICO) question in research and evidence-based practice","volume":"15","author":"Stone","year":"2002","journal-title":"Appl. Nurs. Res."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.pec.2008.11.015","article-title":"How does communication heal? Pathways linking clinician-patient communication to health outcomes","volume":"74","author":"Street","year":"2009","journal-title":"Patient Educ. Couns."},{"key":"ref49","doi-asserted-by":"publisher","first-page":"1837","DOI":"10.1093\/PM\/PNAC077","article-title":"Effectiveness of pain neuroscience education in patients with fibromyalgia: a systematic review and meta-analysis","volume":"23","author":"Suso-Mart\u00ed","year":"2022","journal-title":"Pain Med."},{"key":"ref50","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1097\/AJP.0000000000000594","article-title":"Neurophysiological pain education for patients with chronic low Back pain","volume":"34","author":"Tegner","year":"2018","journal-title":"Clin. J. Pain"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1001\/JAMANEUROL.2018.3376","article-title":"Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low Back pain: a randomized clinical trial","volume":"76","author":"Traeger","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref52","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1037\/\/0022-006x.70.3.678","article-title":"Psychological factors in chronic pain: evolution and revolution","volume":"70","author":"Turk","year":"2002","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref53","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/J.BERH.2007.03.001","article-title":"Quality of life in chronic musculoskeletal pain","volume":"21","author":"T\u00fcz\u00fcn","year":"2007","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref54","doi-asserted-by":"publisher","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010","volume":"380","author":"Vos","year":"2012","journal-title":"Lancet (London, England)."},{"key":"ref55","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/J.JPAIN.2020.03.006","article-title":"Inter-individual differences in the responses to pain neuroscience education in adults with chronic musculoskeletal pain: a systematic review and Meta-analysis of randomized controlled trials","volume":"22","author":"Watson","year":"2021","journal-title":"J. Pain"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"1140.e1","DOI":"10.1016\/J.JPAIN.2019.02.011\/ATTACHMENT\/BD966D05-98F1-4017-9CDD-901E82307708\/MMC1.DOCX","article-title":"Pain neuroscience education for adults with chronic musculoskeletal pain: a mixed-methods systematic review and Meta-analysis","volume":"20","author":"Watson","year":"2019","journal-title":"J. Pain"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1002\/EJP.1314","article-title":"A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-and long-term outcomes of pain and disability","volume":"23","author":"Wood","year":"2019","journal-title":"Eur. J. Pain"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"4199","DOI":"10.3390\/JCM12134199","article-title":"The biology of chronic pain and its implications for pain neuroscience education: state of the art","volume":"12","author":"Zimney","year":"2023","journal-title":"J. Clin. Med."}],"container-title":["Frontiers in Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2023.1272068\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,24]],"date-time":"2023-11-24T03:15:55Z","timestamp":1700795755000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnins.2023.1272068\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,24]]},"references-count":58,"alternative-id":["10.3389\/fnins.2023.1272068"],"URL":"https:\/\/doi.org\/10.3389\/fnins.2023.1272068","relation":{"has-part":[{"id-type":"doi","id":"https:\/\/doi.org\/10.3389\/fnins.2023.1272068.s001","asserted-by":"subject"}]},"ISSN":["1662-453X"],"issn-type":[{"value":"1662-453X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,24]]},"article-number":"1272068"}}