Double-blinded RCT 48 participants assessing whether pain physiology education was capable of changing pain cognitions and pain thresholds in 48 patients with widespread pain and chronic fatigue syndrome. Education: Pain physiology: ‘Explain Pain’ pain system, function, pain mechanisms, and modulation Pacing and self-management, including realistic goals and exacerbation avoidance 3 hours’ worth of pain physiology education (30 minutes) and a workbook for pacing and self-management for 2 weeks
| Pain neurophysiology knowledge improved (P ≤ 0.001) in physiology group Reduced pain catastrophising in the physiology group, no change in the pacing group Reduced pain thresholds in both groups Increased understanding of pain in the physiology group Decreased catastrophising may lead to increased activity Changes in cognition are closely linked to disability and pain Adaptive coping strategies, e.g., distractive rather than maladaptive styles, nearly reached significance
| Butler and Moseley [27]; Meeus et al. [28] |
Preliminary pragmatic study: 65 participants using a convenience sample, establishing whether readiness to change influences pain-related outcomes after receiving an education intervention for people with chronic pain. Outcomes of pain catastrophizing, kinesiophobia, disability, and pain neuroscience knowledge are being assessed. Education: Pre- and post-education PNE PSOCQ before and after education (validated self-report tool) Basic pain education consisting of an introduction to pain philosophy and services available, self-management, and coping Self-management Coping strategies Biomedical approach limitations Pain basics 2-face-to-face session using in-depth PNE 90–120 minutes session
| Significant improvements with pain-related outcomes, including pain disability and pain catastrophising Reduced pain catastrophising (P = 0.01) Improved self-perceived disability Increased knowledge of pain The PNE group had altered readiness to change
| Fletcher et al. [29] |
Compared a single-session pain management skills intervention with a single-session health education intervention and 8 sessions of CBT for adults with chronic low back pain (CLBP). 3-armed RCT 263 adult participants. Education: Single session pain management class delivered by instructors qualified in public health (health education), discussing warning signs, nutrition, medication management, and when to seek help Or 8 weeks of CBT delivered by psychology doctors discussing pain relief skills, CBT techniques, workbooks, relaxation audio files, optional book Or empowered relief (2-hour pain relief skills) discussing PNE, mindfulness, CBT skills, negative thought patterns, action plans, self-soothing, relaxation exercises
| No inferiority for empowered relief compared with 16 hours of CBT for pain catastrophising Empowered relief was superior to health education at 3 months (P < 0.001) Empowered relief was non-inferior to CBT for pain intensity and interference Empowered relief was non-inferior to CBT for sleep disturbance, depression, anxiety, pain behaviour, and bothersomeness Pain catastrophising scores improved with CBT and pain relief skills
| Darnall et al. [30] |
Multicenter RCT 608 participants with chronic pain to assess opioid reduction. Education: 2 groups, enhanced usual care ‘my opioid manager’ booklet 1 group had group-based education aimed at reducing opioids 25 sessions nurse-led, skill-based learning, individual support in community settings Mindfulness-oriented medication and cognitive behavioural approaches 3-day-long, once-weekly trained nurse and layperson with opioid tapering experience Nurse-led individual phone calls, face-to-face meetings, and apps
| No effect on pain interference Reduction in opioid usage (patient-reported) at 12 months 29% patients had discontinued opioids at 12 months 7% had discontinued opioids in the usual group Improved mental health and quality of life (HAD scale and EQ5D5L) Education reduced patient-reported use of opioids
| Sandhu et al. [31] |
RCT 202 participants with acute pain to assess the effect of the education on improving pain outcomes after their initial injury or cause of pain. Education: Intensive education for initial low back pain patients To improve outcomes after injury Physiotherapy clinics HGP practices Clinic rooms 2 1-hour individual face-to-face sessions, either education or placebo Based on ‘Explain Pain’ by Butler and Moseley Biopsychosocial model Topics included: unhelpful beliefs, protective nature of pain The placebo group mimicked the other group but received no advice or education
| No reduction in pain intensity in either group at the primary endpoint Mean pain intensity reduced at 3 months in the education group At 12 months, pain intensity reduced in the education group Reduced disability at 1 week after education and 3 months Reduced catastrophising and unhelpful beliefs reported Recurrent healthcare seeking was lower at 3 months and 12 months
| Butler and Moseley [27]; Traeger et al. [32] |
RCT 272 participants aimed at preventing fear avoidance and promoting coping. Education: Cognitive behaviour group-structured programme including coping, problems, and homework (6 sessions) Pamphlet group including back pain, coping with pain, positive thinking, preventing fear avoidance, and promoting coping Extensive information group ‘Backschool’ approach, lifting, maintaining good posture (6 installments)
| No significant improvement in CBT and pamphlet group for pain experience (P < 0.005) Some ingroup improvements Decreased perception of long-term disability (CBT group) (P < 0.009) Some ‘Pain-free’ days Pain experience improved with CBT and pamphlet group Improved pain catastrophising for all, more so in the information group and pamphlet group from pre-test to follow-up Reduced fear avoidance in all groups CBT group had reduced healthcare use in the following year (P < 0.001) CBT group fared better on long-term sick leave
| Linton and Andersson [34] |
Parallel-arm pilot RCT 35 participants assessing mindfulness and CBT for opioid-treated CLBP. All were prescribed > 30 mg/day of morphine equivalent dose for at least 3 months. Education: Mindfulness and CBT for opioid-treated CLBP Intervention and usual care vs. usual care 8 weekly group sessions plus 30 minutes at home, 6 days a week practice Pharmacology, drug safety, treatment process monitoring, and referral to physical therapy and complementary therapy Experimental group received meditation, CBT for 8 weeks on triggers, mindfulness, and understanding pain and thoughts
| No significant decrease in opioids Improved pain acceptance at 26 weeks compared to baseline Decrease in pain ratings at 26 weeks with meditation Transient improvement in pain ratings after 8 weeks Reduction in disability at 8 weeks, correlating with reduced perceived stress in the meditation-CBT group
| Zgierska et al. [36] |
| Systematic review of the literature on video education tools for chronic illness, including pain; 59 studies; 14 measured medication use (24%). | | Deshpande et al. [35] |
| Systematic review with meta-analysis assessing the effects of education to facilitate knowledge about chronic pain. Comparing PNE with other forms of education. | No reduction in pain severity with education after 2 weeks or 3 months No significant improvements for catastrophising in any study No reduction in depression ratings RMDQ scores showed PNE was significantly better after education Short-term improvement in function PNE was effective at reducing disability
| Geneen et al. [37] |
Study ‘fast school’ 88 participants. Education: 3-hour session by an interprofessional team Topics included pain mechanisms, physical activity, medication management, and pharmacology
| 3 months after attending a session by an interprofessional team, reduced pain interference Reduced pain disability and reduced patient beliefs reported After 3 months, 38% had better functioning After 3 months, 41% better emotional functioning After 3 months, reduced pain interference (P = 0.002) GICS 35% had a positive change 75% had a better understanding of pain
| Trouvin et al. [39] |
