Education-Enhanced Conventional Care versus Conventional Care Alone for Temporomandibular Disorders: A Randomized Controlled Trial

  • Aroldo d.S. Aguiar
    Ph.D. in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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  • G. Lorimer Moseley
    DSc Ph.D, Bradley Distinguished Professor, IIMPACT in Health, University of South Australia, Kaurna Country, Adelaide, Australia
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  • Cesar Bataglion
    Ph.D in Dental Sciences, Professor and Researcher from the Department of Restorative Dentistry at Ribeirão Preto Dental School (FORP), University of São Paulo-USP, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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  • Beatriz Azevedo
    Master's Degree in Progress in Musculoskeletal Rehabilitation, Graduate Program on Rehabilitation and Functional Performance, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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  • Thaís C. Chaves
    Address reprint requests to Thais C. Chaves, Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Avenida Bandeirantes 3900 CEP: 14049 -900 Ribeirão Preto (SP) Brazil.
    Ph.D, Adjunct Professor and Researcher from the Department of Physical Therapy, University Federal of São Carlos, UFSCar, São Carlos, Brazil

    Researcher from the Graduate Program on Rehabilitation and Functional Performance, Laboratory of Research on Movement and Pain (LabMovePain), Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Published:October 08, 2022DOI:


      • PSE with manual therapy and exercises improved disability for chronic TMD.
      • PSE with manual therapy and exercises improved pain intensity for chronic TMD, in the medium-term.
      • PSE addition resulted in longer lasting effects for pain and disability.
      • Pain Self-efficacy and kinesiophobia showed clinically greater effect in the group submitted to PSE.
      • PSE was superior for increasing exercise adherence and pain neurophysiology knowledge.


      The objective of this study was to determine the effect of enhancing conventional care for people with chronic painful temporomandibular disorders (TMD) with an individualised contemporary pain science education (PSE) intervention. In this randomized controlled trial, a consecutive sample of 148 participants (18–55 years of age) was randomized into 2 groups: PSE-enhanced conventional care or Conventional care alone. Conventional care involved a 6-week, 12-session manual therapy and exercise program. The PSE enhancement involved 2 sessions of modern PSE, undertaken in the first 2 treatment sessions. Primary outcomes were pain intensity, assessed with a numeric pain rating scale, and disability, assessed with the craniofacial pain and disability inventory, post-treatment. Linear mixed model analyses were used to investigate between-group differences over time. There was a statistically and clinically meaningful effect of PSE enhancement on disability (Mean Difference = 6.1, 95% CI: 3.3–8.8), but not on pain intensity, post-treatment. Secondary analyses suggested clinically meaningful benefit of PSE enhancement on pain and disability ratings at 10-week and 18-week follow-ups, raising the possibility that preceding conventional care with a PSE intervention may result in long-term benefits.


      The addition of modern Pain Science Education (PSE) intervention improved disability for people with chronic TMD receiving manual therapy and exercise, but not pain. A mean difference in pain and disability favoring the PSE group at the 10- and 18-week follow-ups, respectively, suggests that PSE addition resulted in longer-lasting effects. Trial registration: NCT03926767. Registered on April 29, 2019.

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        • Aguiar AS
        • Visscher CM
        • Bevilaqua-Grossi D
        • Chaves TC
        Cross-cultural adaptation, reliability and construct validity of the Tampa Scale for kinesiophobia for temporomandibular disorders (TSK/TMD-BR) into Brazilian Portuguese.
        J Oral Rehabil. 2017; 44: 500-510
        • Amer-Cuenca JJ
        • Pecos-Martín D
        • Martínez-Merinero P
        • Lluch Girbés E
        • Nijs J
        • Meeus M
        • Ferrer Peña R
        • Fernández-Carnero J
        How much is needed? comparison of the effectiveness of different pain education dosages in patients with fibromyalgia.
        Pain Med. 2020; 21: 782-793
        • Andias R
        • Neto M
        • Silva AG
        The effects of pain neuroscience education and exercise on pain, muscle endurance, catastrophizing and anxiety in adolescents with chronic idiopathic neck pain: a school-based pilot, randomized and controlled study.
        Physiother Theory Pract. 2018; 34: 682-691
        • Armijo-Olivo S
        • Fuentes J
        • da Costa BR
        • Saltaji H
        • Ha C
        • Cummings GG
        Blinding in physical therapy trials and its association with treatment effects: a meta-epidemiological study.
        Am J Phys Med Rehabil. 2017; 96: 34-44
        • Armijo-Olivo S
        • Pitance L
        • Singh V
        • Neto F
        • Thie N
        • Michelotti A
        Effectiveness of manual therapy and therapeutic exercise for temporomandibular disorders: Systematic review and meta-analysis.
        Phys Ther. 2016; 96: 9-25
        • Babatunde OO
        • Jordan JL
        • Van der Windt DA
        • Hill JC
        • Foster NE
        • Protheroe J
        Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence.
        PLoS One. 2017; 12e0178621
        • Beltran-Alacreu H
        • López-de-Uralde-Villanueva I
        • Fernández-Carnero J
        • La Touche R
        Manual therapy, therapeutic patient education, and therapeutic exercise, an effective multimodal treatment of nonspecific chronic neck pain: A randomized controlled trial.
        Am J Phys Med Rehabil. 2015; 94: 887-897
        • Bertolucci PHF
        • Bruck SMD
        • Campacci SR
        • Juliano Y
        O Mini-Exame do Estado Mental em uma população geral: Impacto da escolaridade.
        Arq Neuropsiquiatr. 1994; 52: 1-7
        • Bodes Pardo G
        • Lluch Girbés E
        • Roussel NA
        • Gallego Izquierdo T
        • Jiménez Penick V
        • Pecos Martín D
        Pain neurophysiology education and therapeutic exercise for patients with chronic low back pain: A single-blind randomized controlled trial.
        Arch Phys Med Rehabil. 2018; 99: 338-347
        • Bonatesta L
        • Ruiz-Cárdenas JD
        • Fernández-Azorín L
        • Rodríguez-Juan JJ
        Pain science education plus exercise therapy in chronic nonspecific spinal pain: a systematic review and meta-analyses of randomized clinical trials.
        J Pain. 2022; 23 (2022): 535-546
        • Booth J
        • Moseley GL
        • Schiltenwolf M
        • Cashin A
        • Davies M
        • Hübscher M
        Exercise for chronic musculoskeletal pain: A biopsychosocial approach.
        Musculoskeletal Care. 2017; 15: 413-421
        • Botega NJ
        • Bio MR
        • Zomignani MA
        • Garcia Jr., C
        • Pereira WAB
        Transtornos do humor em enfermaria de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão.
        Saúde Pública. 1995; 5: 355-363
        • Braithwaite FA
        • Walters JL
        • Moseley GL
        • Williams MT
        • McEvoy MP
        A novel blinding protocol to test participant and therapist blinding during dry needling: A randomised controlled experiment.
        Physiotherapy. 2021; 113: 188-198
        • Braithwaite FA
        • Walters JL
        • Moseley GL
        • Williams MT
        • McEvoy MP
        A collaborative experiential problem-solving approach to develop shams for complex physical interventions: A case study of dry needling.
        Physiotherapy. 2021; 113: 177-187
        • Brantingham JW
        • Cassa TK
        • Bonnefin D
        • Pribicevic M
        • Robb A
        • Pollard H
        • Tong V
        • Korporaal C
        Manipulative and multimodal therapy for upper extremity and temporomandibular disorders: A systematic review.
        J Manipulative Physiol Ther. 2013; 36: 143-201
        • Brucki SMD
        • Nitrini R
        • Caramelli P
        • Bertolucci PHF
        • Okamoto IH
        Sugestões para o uso do Mini-Exame do Estado Mental no Brasil.
        Arqui Neuropsiquiatr. 2003; 61: 777-781B
        • Butler D
        • Moseley GL
        Explain Pain.
        2nd ed. Noigroup Publications, Adelaide, Australia2013: 135
        • Calixtre LB
        • Moreira RF
        • Franchini GH
        • Alburquerque-Sendín F
        • Oliveira AB
        Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: A systematic review of randomized controlled trials.
        J Oral Rehabil. 2015; 42: 847-861
        • Catley MJ
        • O'Connell NE
        • Moseley G
        How good is the Neurophysiology of pain questionnaire? A Rasch analysis of psychometric properties.
        J Pain. 2013; 14: 818-827
        • Costa LO
        • Maher CG
        • Latimer J
        • Ferreira PH
        • Ferreira ML
        • Pozzi GC
        • Freitas LM
        Clinimetric testing of three self-report outcome measures for low back pain patients in Brazil: which one is the best?.
        Spine (Phila Pa 1976). 2008; 33: 2459-2463
        • de Lira MR
        • de Oliveira AS
        • França RA
        • Pereira AC
        • Godfrey EL
        • Chaves TC
        The Brazilian Portuguese version of the Exercise Adherence Rating Scale (EARS-Br) showed acceptable reliability, validity and responsiveness in chronic low back pain.
        BMC Musculoskelet Disord. 2020; 21: 294
        • Dickerson SM
        • Weaver JM
        • Boyson AN
        • Thacker JA
        • Junak AA
        • Ritzline PD
        • Donaldson MB
        The effectiveness of exercise therapy for temporomandibular dysfunction: A systematic review and meta-analysis.
        Clin Rehabil. 2017; 31: 1039-1048
        • Dos Santos Aguiar A
        • Bataglion C
        • Felício LR
        • Azevedo B
        • Chaves TC
        Additional effect of pain neuroscience education to craniocervical manual therapy and exercises for pain intensity and disability in temporomandibular disorders: A study protocol for a randomized controlled trial.
        Trials. 2021; 6: 596
        • Dworkin SF
        • LeResche L
        Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique.
        J Craniomandib Disord. 1992; 6: 301-355
        • Galán-Martín MA
        • Montero-Cuadrado F
        • Lluch-Girbes E
        • Coca-López MC
        • Mayo-Iscar A
        • Cuesta-Vargas A
        Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: A randomised trial protocol.
        BMC Musculoskelet Disord. 2019; 3: 505
        • Gallagher L
        • McAuley J
        • Moseley GL
        A randomized controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain.
        Clin J Pain. 2013; 29: 20-25
        • Gatchel RJ
        • Peng YB
        • Peters ML
        • Fuchs PN
        • Turk DC
        The biopsychosocial approach to chronic pain: Scientific advances and future directions.
        Psychol Bull. 2007; 133: 581-624
        • Gil-Martínez A
        • Grande-Alonso M
        • López-de-Uralde-Villanueva I
        • López-López A
        • Fernández-Carnero J
        • La Touche R
        Chronic Temporomandibular Disorders: Disability, pain intensity and fear of movement.
        J Headache Pain. 2016; 17: 103
        • Gil-Martínez A
        • Paris-Alemany A
        • López-de-Uralde-Villanueva I
        • La Touche R
        Management of pain in patients with temporomandibular disorder (TMD): Challenges and solutions.
        J Pain Res. 2018; 11: 571-587
        • Gokhale A
        • Yap T
        • Heaphy N
        • McCullough MJ
        Group pain education is as effective as individual education in patients with chronic temporomandibular disorders.
        J Oral Pathol Med. 2020; 49: 470-475
        • Greghi SM
        • Dos Santos Aguiar A
        • Bataglion C
        • Ferracini GN
        • La Touche R
        • Chaves TC
        Brazilian portuguese version of the craniofacial pain and disability inventory: cross-cultural reliability, internal consistency, and construct and structural validity.
        J Oral Facial Pain Headache. 2018; 32 (389-389)
        • Herrera-Valencia A
        • Ruiz-Muñoz M
        • Martin-Martin J
        • Cuesta-Vargas A
        • González-Sánchez M
        Efficacy of manual therapy in temporomandibular joint disorders and its medium- and long-term effects on pain and maximum mouth opening: A systematic review and meta-analysis.
        J Clin Med. 2020; 9: 3404
        • Kalamir A
        • Bonello R
        • Graham P
        • Vitiello AL
        • Pollard H
        Intraoral myofascial therapy for chronic myogenous temporomandibular disorders: A randomized controlled trial.
        J Manipulative Physiol Ther. 2012; 35: 26-37
        • Kang H
        Sample size determination and power analysis using the G*Power software.
        J Educ Eval Health Prof. 2021; 18: 17
        • La Touche R
        • Martínez García S
        • Serrano García B
        • Proy Acosta A
        • Adraos Juárez D
        • Fernández Pérez JJ
        • Angulo-Díaz-Parreño S
        • Cuenca-Martínez F
        • Paris-Alemany A
        • Suso-Martí L
        Effect of manual therapy and therapeutic exercise applied to the cervical region on pain and pressure pain sensitivity in patients with temporomandibular disorders: A systematic review and meta-analysis.
        Pain Med. 2020; 21: 2373-2384
        • La Touche R
        • Pardo-Montero J
        • Gil-Martínez A
        • Paris-Alemany A
        • Angulo-Díaz-Parreño S
        • Suárez-Falcón JC
        • Lara-Lara M
        • Fernández-Carnero J
        Craniofacial pain and disability inventory (CF-PDI): development and psychometric validation of a new questionnaire.
        Pain Physician. 2014; 17: 95
        • Lee H
        • Lamb SE
        • Bagg MK
        • Toomey E
        • Cashin AG
        • Moseley GL
        Reproducible and replicable pain research: A critical review.
        Pain. 2018; 159: 1683-1689
        • Lee H
        • McAuley JH
        • Hübscher M
        • Kamper SJ
        • Traeger AC
        • Moseley GL
        Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?.
        Pain. 2016; 157: 922-930
        • Lenton PA
        • Truelove EL
        • Ohrbach R
        • Anderson GC
        • Shiffman EL
        The research diagnostic criteria for temporomandibular disorders. II: Reliability of Axis I diagnoses and selected clinical measures.
        J Orofac Pain. 2010; 24: 25-34
        • Lin CS
        Brain signature of chronic orofacial pain: A systematic review and meta-analysis on neuroimaging research of trigeminal neuropathic pain and temporomandibular joint disorders.
        PLoS One. 2014; 9: e94300
        • Lin I
        • Wiles L
        • Waller R
        • Goucke R
        • Nagree Y
        • Gibberd M
        • Straker L
        • Maher CG
        • O'Sullivan PPB
        What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: Systematic review.
        Br J Sports Med. 2020; 54: 79-86
        • List T
        • Jensen RH
        Temporomandibular disorders: Old ideas and new concepts.
        Cephalalgia. 2017; 37: 692-704
        • Lluch E
        • Dueñas L
        • Falla D
        • Baert I
        • Meeus M
        • Sánchez-Frutos J
        • Nijs J
        Preoperative pain neuroscience education combined with knee joint mobilization for knee osteoarthritis.
        Clin J Pain. 2018; 34: 44-52
        • Løchting I
        • Storheim K
        • Werner EL
        • Småstuen Cvancarova M
        • Grotle M
        Evaluation of individualized quality of life and illness perceptions in low back pain: A patient education cluster randomized controlled trial.
        Patient Educ Couns. 2016; 99: 1992-1998
      1. Lourenço RA, Veras, RP, Ribeiro PCC: Confiabilidade teste-reteste do Mini-Exame do Estado Mental em uma população idosa assistida em uma unidade ambulatorial de saúde. Revista Brasileira de Geriatria e Gerontologia [online]. 2008, v. 11, n. 1 [Acessado 24 Maio 2022], pp. 7-16. Disponível em:

        • Louw A
        • Diener I
        • Landers MR
        • Puentedura EJ
        Preoperative pain neuroscience education for lumbar radiculopathy: A multicenter randomized controlled trial with 1-year follow-up.
        Spine. 2014; 39: 1449-1457
        • Louw A
        • Diener I
        • Landers MR
        • Zimney K
        • Puentedura EJ
        Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy.
        J Spine Surg. 2016; 2: 289
        • Louw A
        • Farrell K
        • Landers M
        • Barclay M
        • Goodman E
        • Gillund J
        • McCaffrey S
        • Timmerman L
        The effect of manual therapy and neuroplasticity education on chronic low back pain: A randomized clinical trial.
        J Man Manip Ther. 2017; 25: 227-234
        • Louw A
        • Zimney K
        • Puentedura EJ
        • Diener I
        The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature.
        Physiother Theory Pract. 2016; 32: 332-355
        • Louw A
        • Sluka KA
        • Nijs J
        • Courtney CA
        • Zimney K
        Revisiting the provision of pain neuroscience education: An adjunct intervention for patients but a primary focus of clinician education.
        J Orthop Sports Phys Ther. 2021; 51: 57-59
        • Lövgren A
        • Häggman-Henrikson B
        • Visscher CM
        • Lobbezoo F
        • Marklund S
        • Wänman A
        Temporomandibular pain and jaw dysfunction at different ages covering the lifespan–A population-based study.
        Eur J Pain. 2016; 20: 532-540
        • Macfarlane TV
        • Glenny AM
        • Worthington HV.
        Systematic review of population-based epidemiological studies of oro-facial pain.
        J Dent. 2001; 29: 451-467
        • Malfliet A
        • Kregel J
        • Meeus M
        • Roussel N
        • Danneels L
        • Cagnie B
        • Dolphens M
        • Nijs J
        Blended-learning pain neuroscience education for people with chronic spinal pain: Randomized controlled multicenter trial.
        Phys Ther. 2018; 98: 357-368
        • Martins WR
        • Blasczyk JC
        • Aparecida Furlan de Oliveira M
        • Lagôa Gonçalves KF
        • Bonini-Rocha AC
        • Dugailly PM
        • de Oliveira RJ
        Efficacy of musculoskeletal manual approach in the treatment of temporomandibular joint disorder: A systematic review with meta- analysis.
        Man Ther. 2016; 21: 10-17
        • McNeely ML
        • Armijo-Olivo S
        • Magee DJ
        A systematic review of the effectiveness of physical therapy interventions for temporomandibular disorders.
        Phys Ther. 2006; 86: 710-725
        • Medlicott MS
        • Harris SR
        A systematic review of the effectiveness of exercise manual therapy, electrotherapy, relaxation training and biofeedback in the management of temporomandibular disorder.
        Phys Ther. 2006; 86: 955-973
        • Meeus M
        • Nijs J
        • Van Oosterwijck J
        • Van Alsenoy V
        • Truijen S
        Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: A double-blind randomized controlled trial.
        Arch Phys Med Rehabil. 2010; 91: 1153-1159
        • Moher D
        • Hopewell S
        • Schulz KF
        • Montori V
        • Gøtzsche PC
        • Devereaux PJ
        • Elbourne D
        • Egger M
        • Altman DG
        CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials.
        J Clin Epidemiol. 2010; 63: e1-37
        • Moseley GL
        • Butler D
        Fifteen years of explaining pain: the past, present, and future.
        J Pain. 2015; 16: 807-813
        • Moseley GL
        • Butler J
        Explain Pain Supercharged.
        NOI Group Publishers, Adelaide City West2017: 238
        • Moseley GL
        • Nicholas MK
        • Hodges PW
        A randomized controlled trial of intensive neurophysiology education in chronic low back pain.
        Clin J Pain. 2004; 20: 324-330
        • Moseley L
        Combined physiotherapy and education is efficacious for chronic low back pain.
        Aust J Physiother. 2002; 48: 297-302
        • Nicholas MK
        Self-efficacy and chronic pain.
        in: Paper presented at the annual conference of the British Psychological Society, St. Andrews, Scotland1989
        • Nogueira LAC
        • Chaves AO
        • Nathalia O
        • Almeida RS
        • Reis FJJ
        • Andrade FG
        • Catley MJ
        Cross-cultural adaptation of the revised neurophysiology of pain questionnaire into brazilian portuguese language.
        J Bras Psiquiatr. 2018; 67: 273-277
        • Núñez-Cortés R
        • Espinoza-Ordóñez C
        • Pommer PP
        • Horment-Lara G
        • Pérez-Alenda S
        • Cruz-Montecinos C
        A single preoperative pain neuroscience education: Is it an effective strategy for patients with carpal tunnel syndrome?.
        Med Hypotheses. 2019; 126: 46-50
        • Ohrbach R
        • Dworkin SF
        AAPT Diagnostic Criteria for chronic painful temporomandibular disorders.
        J Pain. 2019; 20: 1276-1292
        • Pate JW
        • Simons LE
        • Rush G
        • Hancock MJ
        • Hush JM
        • Verhagen A
        • Pacey V
        The Concept of Pain Inventory for Adults (COPI-Adult): Assessing knowledge and beliefs regarding pain science education.
        Clin J Pain. 2021; 12: 32-40
        • Pires D
        • Cruz EB
        • Caeiro C
        Aquatic exercise and pain neurophysiology education versus aquatic exercise alone for patients with chronic low back pain: A randomized controlled trial.
        Clin Rehabil. 2015; 29: 538-547
        • Rossettini G
        • Carlino E
        • Testa M
        Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain.
        BMC Musculoskelet Disord. 2018; 22: 27
        • Ryan CG
        • Gray HG
        • Newton M
        • Granat MH
        Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: A pilot randomised controlled trial.
        Man Ther. 2020; 15: 382-387
        • Salaffi F
        • Stancati A
        • Silvestri CA
        • Ciapetti A
        • Grassi W
        Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale.
        Eur J Pain. 2004; 8: 283-291
        • Saracoglu I
        • Arik MI
        • Afsar E
        • Gokpinar HH
        The effectiveness of pain neuroscience education combined with manual therapy and home exercise for chronic low back pain: A single-blind randomized controlled trial.
        Physiother Theory Pract. 2020; 19: 1-11
        • Sardá J
        • Nicholas MK
        • Pimenta CA
        • Asghari A
        Pain-related self-efficacy beliefs in a Brazilian chronic pain patient sample: A psychometric analysis.
        Stress Health. 2007; 23: 185-190
        • Sehn F
        • Chachamovich E
        • Vidor LP
        • Dall-Agnol L
        • de Souza IC
        • Torres IL
        • Fregni F
        • Caumo W
        Cross-cultural adaptation and validation of the Brazilian Portuguese version of the pain catastrophizing scale.
        Pain Med. 2012; 13: 1425-1435
        • Siddall B
        • Ram A
        • Jones MD
        • Booth J
        • Perriman D
        • Summers SJ
        Short-term impact of combining pain neuroscience education with exercise for chronic musculoskeletal pain: A systematic review and meta-analysis.
        Pain. 2022; 163: e20-e30
        • Téllez-García M
        • de-la-Llave-Rincón AI
        • Salom-Moreno J
        • Palacios-Ceña M
        • Ortega-Santiago R
        Fernández-de-Las-Peñas C: Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: A preliminary clinical trial.
        J Bodyw Mov Ther. 2015; 19: 464-472
        • Traeger AC
        • Lee H
        • Hübscher M
        • Skinner IW
        • Moseley GL
        • Nicholas MK
        • Henschke N
        • Refshauge KM
        • Blyth FM
        • Main CJ
        • Hush JM
        • Lo S
        • McAuley JH
        Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low back pain: a randomized clinical trial.
        JAMA Neurol. 2019; 76: 161-169
        • Treede RD
        • Rief W
        • Barke A
        • Aziz Q
        • Bennett MI
        • Benoliel R
        • Cohen M
        • Evers S
        • Finnerup NB
        • First MB
        • Giamberardino MA
        • Kaasa S
        • Kosek E
        • Lavand'homme P
        • Nicholas M
        • Perrot S
        • Scholz J
        • Schug S
        • Smith BH
        • Svensson P
        • Vlaeyen JWS
        • Wang SJ
        A classification of chronic pain for ICD-11.
        Pain. 2015; 156: 1003-1007
        • Valiente-Castrillo P
        • Martín-Pintado-Zugasti A
        • Calvo-Lobo C
        • Beltran-Alacreu H
        • Fernández-Carnero J
        Effects of pain neuroscience education and dry needling for the management of patients with chronic myofascial neck pain: A randomized clinical trial.
        Acupunct Med. 2021; 39: 91-105
        • van Ittersum MW
        • van Wilgen CP
        • van der Schans CP
        • Lambrecht L
        • Groothoff JW
        • Nijs J
        Written pain neuroscience education in fibromyalgia: A multicenter randomized controlled trial.
        Pain Pract. 2014; 14: 689-700
        • Van Oosterwijck J
        • Meeus M
        • Paul L
        • De Schryver M
        • Pascal A
        • Lambrecht L
        • Nijs J
        Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial.
        Clin J Pain. 2013; 29: 873-882
        • Watson JA
        • Ryan CG
        • Cooper L
        • Ellington D
        • Whittle R
        • Lavender M
        • Dixon J
        • Atkinson G
        • Cooper K
        • Martin DJ
        Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis.
        J Pain. 2019; 20: 1140.e1-1140.e22
        • Werner EL
        • Storheim K
        • Løchting I
        • Wisløff T
        • Grotle M
        Cognitive patient education for low back pain in primary care: A cluster randomized controlled trial and cost-effectiveness analysis.
        Spine (Phila Pa 1976). 2016; 41: 455-462
        • Wood L
        • Hendrick PA
        A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: Short-and long-term outcomes of pain and disability.
        Eur J Pain. 2019; 23: 234-249
        • Leake HB
        • Mardon A
        • Stanton TR
        • Harvie DS
        • Butler DS
        • Karran EL
        • Wilson D
        • Booth J
        • Barker T
        • Wood P
        • Fried K
        • Hayes C
        • Taylor L
        • Macoun M
        • Simister A
        • Moseley GL
        • Berryman C
        Key learning statements for persistent pain education: an iterative analysis of consumer, clinician and researcher perspectives and development of public messaging.
        J Pain. 2022; (S1526-5900(22)00367-4, [Epub ahead of print])