Pain Neuroscience Education in Physiotherapy Management of Knee Osteoarthritis: A Review for Clinical Practice and Research

Background: Knee osteoarthritis (KOA) is one of the most prevalent causes of pain and disability worldwide. Traditional physiotherapy has primarily focused on biomechanical and exercise-based management. However, growing evidence suggests that pain neuroscience education (PNE) can enhance outcomes by addressing maladaptive pain beliefs and central sensitisation. Objective: To review the current evidence (2020–2025) regarding the effectiveness of PNE as an adjunct to physiotherapy interventions in the management of KOA. Methods: A structured literature search was conducted in PubMed using predefined terms related to PNE and knee osteoarthritis. Randomised controlled trials (RCTs), feasibility studies, systematic reviews, and narrative reviews published between 2020 and 2025 were included. Results: Ten key studies, including systematic reviews, RCTs, and clinical trials, were analysed. PNE interventions were consistently associated with reduced pain intensity, improved pain self-efficacy, and enhanced functional outcomes when combined with physiotherapy exercises. Studies also reported psychosocial benefits such as decreased catastrophizing, fear-avoidance, and improved movement confidence. Conclusion: Incorporating PNE into physiotherapy management for KOA can address both physical and cognitive dimensions of pain, potentially improving treatment outcomes. Further research with standardised protocols and long-term follow-up is recommended.