Pain beliefs, treatment expectations, and treatment experiences in spinal pain – a scoping review of qualitative studies

Objectives: To provide a comprehensive overview of qualitative studies on three key perspectives of patients with nonspecific back and neck pain – pain beliefs, treatment expectations, treatment experiences, and their interaction. Methods: Literature search was conducted in PubMed and CINAHL and included articles from inception to 1 October 2025. Two reviewers screened the records for eligibility in a two-step process. Data were charted and synthesized narratively. Results: Twenty-four studies involving a total of 666 participants were included. Most patients held biomedical pain beliefs and sought a specific diagnosis for their condition. Such a diagnosis influenced treatment expectations, which were in turn linked to previous treatment experiences. A need for pain validation, often expected to be confirmed through diagnostic imaging, emerged as an overarching theme. This need can be addressed by the health professionals’ empathy and genuine interest in participatory engagement, their perceived competence, e.g. reflected by a thorough physical examination, and their guidance toward patient self-management considering individual barriers. Conclusions: Patients’ beliefs, expectations, and experiences were connected by an underlying need for validation of their pain experience. Incorporating empathetic, individually tailored pain validation, distinct from solicitousness and mere reassurance, into spinal management might improve treatment satisfaction and outcomes.