{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:43:16Z","timestamp":1790790196410,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"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:p>Chronic pain management increasingly emphasizes patient self-management behaviors such as regular physical activity, restorative sleep, stress regulation, and healthful nutrition. Education is commonly used to support these aims; however, improving knowledge alone rarely produces sustained behavior change. In this Perspective, an argument will be made that effective chronic pain management requires a deliberate shift from education-focused approaches alone toward clinician-supported behavior change. Education may be necessary to reconceptualize pain and reduce perceived threat, though it is insufficient to help patients consistently adopt and sustain health-promoting behaviors in the context of pain. Drawing on pain science, health behavior change theory, and behavioral medicine, behavior change will be distinguished from education, and practical techniques will be outlined that clinicians can use to support patients in translating knowledge into action. Key principles include tailoring interventions to a patient\u2019s stage of change, fostering self-efficacy through graded mastery experiences, using motivational interviewing to elicit values-based motivation and address ambivalence, and employing collaborative goal setting and action planning. The role of action planning, graded tasks, and motivational interviewing approaches to sustain behavior change will be emphasized. This paper will provide a clinician-focused roadmap for supporting behavior change in pain care. By moving beyond education toward intentional behavior change support, clinicians can better foster resilience, functional recovery, and sustainable self-management among individuals living with chronic pain.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1876192","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:02:49Z","timestamp":1787724169000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Knowing isn\u2019t doing: a behavior change perspective on chronic pain management"],"prefix":"10.3389","volume":"14","author":[{"given":"Janet R.","family":"Bezner","sequence":"first","affiliation":[{"name":"Department of Physical Therapy, Texas State University","place":["Round Rock, TX, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"ref1","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":"2007","journal-title":"Phys Ther Rev"},{"key":"ref2","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":"ref3","doi-asserted-by":"publisher","first-page":"104425","DOI":"10.1016\/j.jpain.2023.11.008","article-title":"Teaching patients about pain: the emergence of pain science education, its learning frameworks and delivery strategies","volume":"25","author":"Moseley","year":"2024","journal-title":"J Pain"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"57","DOI":"10.2519\/jospt.2021.9804","article-title":"Revisiting the provision of pain neuroscience education: an adjunct intervention for patients but a primary focus of clinician education","volume":"51","author":"Louw","year":"2021","journal-title":"J Orthop Sports Phys Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1016\/j.jpain.2022.07.005","article-title":"Individualized exercise in chronic non-specific low back pain: a systematic review and meta-analysis","volume":"23","author":"Fleckenstein","year":"2022","journal-title":"J Pain"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"101467","DOI":"10.1016\/j.smrv.2021.101467","article-title":"Prevalence of sleep disturbances in patients with chronic non-cancer pain: a systematic review and meta-analysis","volume":"57","author":"Sun","year":"2021","journal-title":"Sleep Med Rev"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1186\/s12891-022-05318-5","article-title":"The effectiveness of non-pharmacological sleep interventions for people with chronic pain: a systematic review and meta-analysis","volume":"23","author":"Whale","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s12160-016-9844-2","article-title":"Mindfulness meditation for chronic pain: a systematic review and meta-analysis","volume":"51","author":"Hilton","year":"2017","journal-title":"Ann Behav Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1093\/pm\/pnaa378","article-title":"Dietary interventions are beneficial for patients with chronic pain: a systematic review with meta-analysis","volume":"22","author":"Field","year":"2021","journal-title":"Pain Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/jhn.12601","article-title":"A systematic review and meta-analysis of nutrition interventions for chronic noncancer pain","volume":"32","author":"Brain","year":"2018","journal-title":"J Hum Nutr Diet"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"100578","DOI":"10.1016\/j.bjpt.2023.100578","article-title":"Striving for better outcomes of treating chronic pain: integrating behavioural change strategies before, during, and after modern pain science education","volume":"27","author":"Roose","year":"2023","journal-title":"Braz J Phys Ther"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1111\/jep.13644","article-title":"Synthesis of clinical practice guideline recommendations for the primary health care of chronic musculoskeletal pain","volume":"28","author":"Ernstzen","year":"2022","journal-title":"J Eval Clin Pract"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1169178","DOI":"10.3389\/fpain.2023.1169178","article-title":"Applying the behavioural change wheel to guide the implementation of a biopsychosocial approach to musculoskeletal pain care","volume":"4","author":"Ng","year":"2023","journal-title":"Front Pain Res"},{"key":"ref14","volume-title":"WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings","year":"2023"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"S620","DOI":"10.1007\/s11606-010-1426-6","article-title":"Linking a motivational interviewing curriculum to the chronic care model","volume":"25","author":"Abramowitz","year":"2010","journal-title":"J Gen Intern Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1186\/s12875-020-01317-4","article-title":"Agenda setting and visit openings in primary care visits involving patients taking opioids for chronic pain","volume":"22","author":"Hood-Medland","year":"2021","journal-title":"BMC Fam Pract"},{"key":"ref17","volume-title":"Coaching Psychology Manual","author":"Moore","year":"2016"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1037\/a0012801","article-title":"Self-determination theory: a macrotheory of human motivation, development, and health","volume":"49","author":"Deci","year":"2008","journal-title":"Can Psychol"},{"key":"ref19","volume-title":"Motivational Interviewing: Helping People Change","author":"Miller","year":"2013"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1037\/0033-295X.84.2.191","article-title":"Self-efficacy: toward a unifying theory of behavioral change","volume":"84","author":"Bandura","year":"1977","journal-title":"Psychol Rev"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"38","DOI":"10.4278\/0890-1171-12.1.38","article-title":"The transtheoretical model of health behavior change","volume":"12","author":"Prochaska","year":"1997","journal-title":"Am J Health Promot"},{"key":"ref22","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":"ref23","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s12160-013-9486-6","article-title":"The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus","volume":"46","author":"Michie","year":"2013","journal-title":"Ann Behav Med"},{"key":"ref24","volume-title":"Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors","author":"Marlatt","year":"2005"},{"key":"ref25","doi-asserted-by":"crossref","DOI":"10.1037\/17335-000","volume-title":"Acceptance and Commitment Therapy: The Process and Practice of Mindful Change","author":"Hayes","year":"2012"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1111\/pme.12929","article-title":"Cognitive-motivational influences on health behavior change in adults with chronic pain","volume":"17","author":"Anderson","year":"2016","journal-title":"Pain Med"},{"key":"ref27","volume-title":"Curiosity: The Opposite of Judgmental is Not Non-Judgmental","author":"Matthews","year":"2021"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1002\/zoo.21704","article-title":"Facilitating behavior change: introducing the transtheoretical model of behavior change as a conservation psychology framework and tool for practitioners","volume":"41","author":"Walton","year":"2022","journal-title":"Zoo Biol"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"e844","DOI":"10.1097\/PR9.0000000000000844","article-title":"Implementing a behavioral medicine approach in physiotherapy for patients with musculoskeletal pain: a scoping review","volume":"5","author":"Soderlund","year":"2020","journal-title":"Pain Rep"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"303","DOI":"10.3390\/jcm10020303","article-title":"Adherence to and the maintenance of self-management behaviour in older people with musculoskeletal pain\u2014a scoping review and theoretical models","volume":"10","author":"Soderlund","year":"2021","journal-title":"J Clin Med"},{"key":"ref31","year":"2023"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"E124","DOI":"10.1519\/JPT.0000000000000402","article-title":"Interventions to improve long-term adherence to physical rehabilitation: a systematic review","volume":"47","author":"Burke","year":"2024","journal-title":"J Geriatr Phys Ther"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"kaag011","DOI":"10.1093\/abm\/kaag011","article-title":"Behavioral change techniques and patient co-design in programs for hand osteoarthritis: a scoping review with directed content analysis","volume":"60","author":"Pouliopoulou","year":"2026","journal-title":"Ann Behav Med"},{"key":"ref34","year":"2026"},{"key":"ref35","year":"2024"},{"key":"ref36","year":"2024"},{"key":"ref37","volume-title":"Stress in America\u2122 2025: A Crisis of Connection","year":"2025"},{"key":"ref38","year":"2024"},{"key":"ref39","volume-title":"The area responsible is the Food and Nutrition Administration (formerly Food and Nutrition Service)","year":"2026"},{"key":"ref40","year":"2024"},{"key":"ref41","year":""},{"key":"ref42","doi-asserted-by":"publisher","first-page":"115","DOI":"10.2519\/josptopen.2024.1130","article-title":"Are US adults with chronic health conditions meeting public health recommendations for physical activity?","volume":"2","author":"Alqahtani","year":"2024","journal-title":"JOSPT Open"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"e10658","DOI":"10.1002\/jbm4.10658","article-title":"The importance of sleep for people with chronic pain: current insights and evidence","volume":"6","author":"Whale","year":"2022","journal-title":"JBMR Plus"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"4705","DOI":"10.1038\/s41598-024-55449-z","article-title":"Eating habits and the desire to eat healthier among patients with chronic pain: a registry-based study","volume":"14","author":"Dong","year":"2024","journal-title":"Sci Rep"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1806","DOI":"10.3390\/jcm11071806","article-title":"Implementation of online behavior modification techniques in the management of chronic musculoskeletal pain: a systematic review and meta-analysis","volume":"11","author":"Cuenca-Mart\u00ednez","year":"2022","journal-title":"J Clin Med"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"7303205060p1","DOI":"10.5014\/ajot.2019.028555","article-title":"Effectiveness of pacing as a learned strategy for people with chronic pain: a systematic review","volume":"73","author":"Guy","year":"2019","journal-title":"Am J Occup Ther"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e69100","DOI":"10.2196\/69100","article-title":"Patients\u2019 experiences of digital health interventions for the self-management of chronic pain: systematic review and thematic synthesis","volume":"27","author":"Main","year":"2025","journal-title":"J Med Internet Res"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"846","DOI":"10.1093\/ptj\/pzaa021","article-title":"Integrating motivational interviewing in pain neuroscience education for people with chronic pain: a practical guide for clinicians","volume":"100","author":"Nijs","year":"2020","journal-title":"Phys Ther"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1016\/j.jpain.2015.10.021","article-title":"The efficacy of motivational interviewing in adults with chronic pain: a meta-analysis and systematic review","volume":"17","author":"Alperstein","year":"2016","journal-title":"J Pain"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1876192\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:02:51Z","timestamp":1787724171000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1876192\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,26]]},"references-count":49,"alternative-id":["10.3389\/fpubh.2026.1876192"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1876192","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,26]]},"article-number":"1876192"}}