{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T11:26:16Z","timestamp":1787052376428,"version":"build-2736575974"},"reference-count":58,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"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. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic pain affects approximately 20% of the global population. In primary care settings, chronic pain may account for up to 37.5% of weekly consultations. Most chronic pain is non-specific, complicating diagnosis and treatment. Kinesiophobia and movement avoidance may accompany chronic pain, necessitating a biopsychosocial approach to treatment. Pain neuroscience education and corrective exercise have been proposed as treatment strategies. This review aims to critically examine the relationships among kinesiophobia, movement avoidance, and chronic pain; assess the effectiveness of pain neuroscience education; and present a practical framework to guide diagnosis and treatment within integrated primary care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Literature searches in PubMed, PsycInfo, CINAHL, and Google Scholar utilized the search terms chronic pain, kinesiophobia, fear of movement, fear of falling, backache, arthritis, neuroscience education, neuroeducation, balance, and proprioception. Inclusion criteria included English language, peer-reviewed literature published over the past 10 years. Exclusion criteria included studies not published in English and gray literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both kinesiophobia and movement avoidance were significantly correlated with non-specific chronic pain, particularly among older adults. However, the relationship between kinesiophobia and movement avoidance was not direct. Pain neuroscience education combined with strengthening exercises had a positive impact on chronic pain, movement avoidance, and kinesiophobia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Based on their findings, authors collaborated on a treatment strategy for integrated primary care settings, focusing on patient engagement, pain neuroscience education, balance assessment, and corrective exercise. More research is needed to further explain relationships between chronic pain, kinesiophobia, and movement avoidance, and the best strategies for managing these conditions in primary care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1863881","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:35:00Z","timestamp":1787049300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Use of pain neuroscience education, balance evaluation, and exercise for treating chronic pain with kinesiophobia: a narrative review with clinical recommendations"],"prefix":"10.3389","volume":"14","author":[{"given":"Nina H.","family":"Russin","sequence":"first","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix","place":["AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"Peterson","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix","place":["AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Pardon","sequence":"additional","affiliation":[{"name":"Arizona State University Library, Arizona State University, Phoenix","place":["AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew Perry","family":"Martin","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix","place":["AZ, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1098100","DOI":"10.3389\/fpubh.2023.1098100","article-title":"Global and regional estimates of clinical and economic burden of low back pain in high-income countries: a systematic review and meta-analysis","volume":"11","author":"Fatoye","year":"2023","journal-title":"Front. Public Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"72","DOI":"10.15585\/mmwr.mm7215a1","article-title":"Chronic pain among adults\u2014United States, 2019\u20132021","author":"Rikard","year":"2023","journal-title":"MMWR Morbidity and Mortality Weekly Report."},{"key":"B3","unstructured":"2026"},{"key":"B4","doi-asserted-by":"publisher","first-page":"215013272110080","DOI":"10.1177\/21501327211008055","article-title":"Diagnosing and treating chronic pain: are we doing this right?","volume":"12","author":"Carnago","year":"2021","journal-title":"J Primary Care and Community Health"},{"key":"B5","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1097\/MLR.0000000000002181","article-title":"Economic costs of chronic pain\u2014United States, 2021","author":"Guy","year":"2025","journal-title":"Med Care."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2024.104614","article-title":"Prevalence and sociodemographic correlates of chronic pain among a nationally representative sample of older adults in the United States","author":"LaRowe","year":"2024","journal-title":"J Pain."},{"key":"B7","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":"B8","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12877-016-0302-6","article-title":"Kinesiophobia and its relation to pain characteristics and cognitive affective variables in older adults with chronic pain","volume":"16","author":"Larsson","year":"2016","journal-title":"BMC Geriatrics."},{"key":"B9","doi-asserted-by":"publisher","first-page":"933483","DOI":"10.3389\/fnbeh.2022.933483","article-title":"Treatments for kinesiophobia in people with chronic pain: a scoping review","volume":"16","author":"Bordeleau","year":"2022","journal-title":"Front Behav Neurosci."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/ejp.2182","article-title":"Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: a systematic review and meta-analysis of randomized controlled trials","author":"Lin","year":"2023","journal-title":"Eur J Pain"},{"key":"B11","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/j.jbmt.2024.11.016","article-title":"Effect of pain neuroscience education+ (PNE+) in people with different mechanisms of chronic pain: a systematic review and meta-analysis","volume":"41","author":"Tatikola","year":"2025","journal-title":"J Bodywork Mov Ther."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1186\/s40001-025-03304-w","article-title":"Association between chronic pain severity, falls, frailty and perceived health in older adults at risk of falls","volume":"30","author":"Anbarasan","year":"2025","journal-title":"Eur J Med Res."},{"key":"B13","unstructured":"2026"},{"key":"B14","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/j.1532-5415.2010.03214.x","article-title":"Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study","volume":"59","author":"Katzman","year":"2011","journal-title":"J Am Geriatrics Society"},{"key":"B15","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1097\/01.wnn.0000163577.92515.11","article-title":"\u2018Fear of falling' gait","volume":"18","author":"Kurlan","year":"2005","journal-title":"Cogn Behav Neurol."},{"key":"B16","unstructured":"Geneva\n          World Health Organization.\n          Low Back Pain\n          \n          2023"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.3390\/medicina59071268","article-title":"Carryover effects of pain neuroscience education on patients with chronic lower back pain: a systematic review and meta-analysis","volume":"59","author":"Shin","year":"2023","journal-title":"Medicina."},{"key":"B18","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1080\/10669817.2017.1323699","article-title":"A clinical perspective on a pain neuroscience education approach to manual therapy","volume":"25","author":"Louw","year":"2017","journal-title":"J Manual Manipul Ther."},{"key":"B19","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/S0272-7358(98)00034-8","article-title":"Beyond pain","volume":"19","author":"Asmundson","year":"1999","journal-title":"Clin Psychol Rev."},{"key":"B20","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1016\/S0304-3959(99)00242-0","article-title":"Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art","volume":"85","author":"Vlaeyen","year":"2000","journal-title":"Pain."},{"key":"B21","first-page":"222","article-title":"The tampa scale of kinesiophobia and neck pain, disability, and range of motion: a narrative review of the literature","volume":"55","author":"Hudes","year":"2011","journal-title":"J Canad Chiropr Assoc."},{"key":"B22","doi-asserted-by":"publisher","first-page":"34","DOI":"10.4274\/tod.galenos.2025.93798","article-title":"Understanding kinesiophobia in chronic mechanical low back pain: an analysis of contributing factors","volume":"31","author":"Karamanlio\u011flu","year":"2025","journal-title":"Tur J Osteopor."},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1186\/s42358-025-00485-0","article-title":"Associations between kinesiophobia, pain, functional disability, balance confidence and transverse abdomen muscle activation in elderly individuals with chronic nonspecific low back pain: a cross-sectional study","author":"Torres Cruz","year":"2025","journal-title":"Adv Rheumatol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e0337553","DOI":"10.1371\/journal.pone.0337553","article-title":"Association between pain, physical performance, and kinesiophobia in older women with low back pain: a cross-sectional study","volume":"21","author":"Saki","year":"2026","journal-title":"PLoS ONE."},{"key":"B25","doi-asserted-by":"publisher","first-page":"456","DOI":"10.3390\/healthcare14040456","article-title":"\u2018Learn and move' program for the management of chronic musculoskeletal pain in primary care: a pilot study","volume":"14","author":"Ort\u00edz-Mallas\u00e9n","year":"2026","journal-title":"Healthcare"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.1016\/j.apmr.2025.04.022","article-title":"Real-time assessment of resilience in individuals with spinal cord injury and chronic pain: a feasibility, reliability, and validity study","volume":"106","author":"Kuzu","year":"2025","journal-title":"Archiv Phy Med Rehabil."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0334144","article-title":"Indirect associations of pain resilience and kinesiophobia with the relationship between physical activity and chronic pain","author":"Niederstrasser","year":"2025","journal-title":"PLoS ONE."},{"key":"B28","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1093\/ptj\/pzab076","article-title":"Influence of baseline kinesiophobia levels on treatment outcome in people with chronic spinal pain","author":"Van Bogaert","year":"2021","journal-title":"Phys Ther."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12889-024-19930-8","article-title":"Breaking the cycle of reoccurring low back pain with integrated motivational interviewing and cognitive behavioural therapy to facilitate education and exercise advice: a superiority randomised controlled trial study protocol","volume":"24","author":"Watson","year":"2024","journal-title":"BMC Public Health."},{"key":"B30","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":"2020","journal-title":"Pain Prac."},{"key":"B31","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":"2022","journal-title":"J Pain."},{"key":"B32","volume-title":"Social Learning Theory","author":"Bandura","year":"1971"},{"key":"B33","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.mporth.2020.03.009","article-title":"The gait cycle and its variations with disease and injury","volume":"34","author":"Shah","year":"2020","journal-title":"Orthopaed Trauma."},{"key":"B34","doi-asserted-by":"publisher","first-page":"2296","DOI":"10.1097\/j.pain.0000000000002929","article-title":"Reductions in kinesiophobia and distress after pain neuroscience education and exercise lead to favourable outcomes: a secondary mediation analysis of a randomized controlled trial in primary care","volume":"164","author":"Murillo","year":"2023","journal-title":"Pain."},{"key":"B35","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/j.jphys.2025.09.005","article-title":"Pain self-efficacy, kinesiophobia and health-related quality of life mediate pain and disability improvements with goal setting and education in people with chronic low back pain: a mediation analysis of a randomised trial","volume":"71","author":"Walker","year":"2025","journal-title":"J Physiother."},{"key":"B36","doi-asserted-by":"publisher","first-page":"M85","DOI":"10.1037\/t56530-000","article-title":"Short physical performance battery","volume":"49","author":"Guralnik","year":"1994","journal-title":"PsycTESTS Dataset."},{"key":"B37","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1111\/j.1532-5415.2006.00701.x","article-title":"Meaningful change and responsiveness in common physical performance measures in older adults","volume":"54","author":"Perera","year":"2006","journal-title":"J Am Geriatr Society"},{"key":"B38","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1007\/BF03327424","article-title":"Concordance and discordance between two measures of lower extremity function: 400 meter self-paced walk and SPPB","volume":"18","author":"Sayers","year":"2006","journal-title":"Aging Clin Exp Res."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1016\/j.apmr.2012.03.024","article-title":"Comparative study of short forms of the tampa scale for kinesiophobia: fear of movement in a surgical spine population","volume":"938","author":"Archer","year":"2012","journal-title":"Archiv Phy Med Rehabil."},{"key":"B40","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1097\/00002508-199103000-00053","article-title":"The tampa scale: a measure of kinesiophobia","volume":"7","author":"Miller","year":"1991","journal-title":"Clin J Pain."},{"key":"B41","unstructured":"2026"},{"key":"B42","unstructured":""},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.2217\/pmt-2021-0118","article-title":"The use of patient-led goal setting in the intervention of chronic low back pain in adults: a narrative review","author":"Rogers","year":"2022","journal-title":"Pain Manag."},{"key":"B44","doi-asserted-by":"publisher","first-page":"gnae010","DOI":"10.1093\/geront\/gnae010","article-title":"Non-Pharmacological interventions for chronic pain in older adults: a systematic review and meta-analysis","volume":"64","author":"Leung","year":"2024","journal-title":"Gerontologist."},{"key":"B45","doi-asserted-by":"crossref","DOI":"10.4324\/9781315801933","volume-title":"Goal Attainment Scaling","author":"Kiresuk","year":"2014"},{"key":"B46","doi-asserted-by":"publisher","first-page":"e0267157","DOI":"10.1371\/journal.pone.0267157","article-title":"The clinical impact of pain neuroscience continuing education on physical therapy outcomes for patients with low back and neck pain","volume":"17","author":"Louw","year":"2022","journal-title":"PLoS ONE."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain","volume":"71","author":"Dowell","year":"2022","journal-title":"MMWR. Recommend Rep."},{"key":"B48","doi-asserted-by":"publisher","first-page":"e35872","DOI":"10.1097\/MD.0000000000035872","article-title":"A scientometric analysis and visualization of kinesiophobia research from 2002 to 2022: a review","volume":"102","author":"Li","year":"2023","journal-title":"Medicine."},{"key":"B49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2519\/jospt.2025.12777","article-title":"Are tailored interventions to modifiable psychosocial risk factors effective in reducing pain intensity and disability in low back pain? a systematic review with meta-analysis of randomized trials","volume":"55","author":"Pouya","year":"2025","journal-title":"J Orthop Sports Phy Ther."},{"key":"B50","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1186\/s12891-023-06504-9","article-title":"Construct validity of the Mini-BESTest in individuals with chronic pain in specialized pain care","volume":"24","author":"Wagner","year":"2023","journal-title":"BMC Muscul Disord."},{"key":"B51","doi-asserted-by":"publisher","first-page":"e328","DOI":"10.1097\/j.pain.0000000000002291","article-title":"The prevalence of chronic pain among adults in the United States","volume":"163","author":"Yong","year":"2021","journal-title":"Pain"},{"key":"B52","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.1016\/j.jamda.2020.09.038","article-title":"The short physical performance battery (SPPB): a quick and useful tool for fall risk stratification among older primary care patients","volume":"22","author":"Welch","year":"2020","journal-title":"J Am Med Dir Assoc."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1675","DOI":"10.2147\/JPR.S310775","article-title":"Changes in trunk variability and stability of gait in patients with chronic low back pain: impact of laboratory versus daily-living environments","volume":"14","author":"Nishi","year":"2021","journal-title":"J Pain Res."},{"key":"B54","doi-asserted-by":"publisher","first-page":"594","DOI":"10.3122\/jabfm.2014.05.130311","article-title":"Comparing chronic pain treatment seekers in primary care versus tertiary care settings","volume":"27","author":"Fink-Miller","year":"2014","journal-title":"J Am Board Family Med."},{"key":"B55","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1097\/j.pain.0000000000002303","article-title":"Relationship between gait complexity and pain attention in chronic low back pain","volume":"163","author":"Homs","year":"2021","journal-title":"Pain, Publish."},{"key":"B56","unstructured":"Dydyk\n              AM\n            \n            \n              Givler\n              A\n            \n          \n          Central Pain Syndrome\n          \n          2021"},{"key":"B57","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1093\/ptj\/pzx092","article-title":"Blended-learning pain neuroscience education for people with chronic spinal pain: randomized controlled multicenter trial","volume":"98","author":"Malfliet","year":"2017","journal-title":"Physical Ther."},{"key":"B58","doi-asserted-by":"publisher","first-page":"2108","DOI":"10.1016\/j.pain.2013.12.010","article-title":"Constructing and deconstructing the gate theory of pain","volume":"155","author":"Mendell","year":"2014","journal-title":"Pain"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1863881\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:35:02Z","timestamp":1787049302000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1863881\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":58,"alternative-id":["10.3389\/fpubh.2026.1863881"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1863881","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"article-number":"1863881"}}