LAUSR

ABSTRACT Chronic spinal pain poses complex challenges for healthcare around the world and is in need of effective interventions. Pain Neuroscience Education (PNE) is a promising intervention hypothesized to improve pain and disability by changing individuals' beliefs, perceptions and expectations about pain. PNE has shown promise in small, controlled trials when implemented in tightly controlled situations. Exploration of promising interventions through more pragmatic methodologies is a crucial but under-studied step towards improving outcomes in routine clinical care. The purpose was to examine the impact of pragmatic PNE training on clinical outcomes in patients with chronic spine pain.The cluster-randomized clinical trial took place in 45 outpatient PT clinics. Participants included 108 physical therapists (45 clinics, 16 clusters) and 319 patients. Clusters of PT clinics were randomly assigned to either receive training in PNE or no intervention and continue with usual care (UC).We found no significant differences between groups for our primary outcome at 12 weeks, Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function computer adaptive test (CAT), (mean difference = 1.05 [95% CI: -0.73, 2.83], p=0.25). The PNE group demonstrated significant greater improvements in pain self-efficacy at 12 and 2 weeks compared to no intervention [mean difference = 3.65 (95% CI; 0.00 - 7.29), p=0.049 and = 3.08 95% CI: 0.07, - 6.09), p=0.045, respectively]. However, a similar percentage of participants in both control (41.1%) and treatment (44.4%) groups reported having received the treatment per fidelity question (yes or no to pain discussed as a perceived threat) at 2 weeks.Pragmatic PT PNE training and delivery failed to produce significant functional changes in patients with chronic spinal pain but did produce significant improvement in pain self-efficacy over usual care PT.