Feasibility of Gamified Web-Based Pain Neuroscience Education for Chronic Low Back Pain

AIM: To develop a web-based pain neuroscience education intervention based on patients' beliefs and evaluate its feasibility, engagement, and preliminary clinical effects in chronic low back pain. BACKGROUND: Up to 90% of patients with low back pain have not received a clear explanation for the source of their pain. Web-based educational interventions offer a promising avenue to improve knowledge and self-management behaviors in chronic pain populations. METHODS: This was a mixed-method exploratory sequential study designed as a pilot feasibility trial. Following a qualitative phase (n = 16) to inform content development, a randomized controlled trial was conducted with 48 patients in primary care. The 15-day intervention group (n = 26) accessed a gamified website, while the control group (n = 22) followed conventional care. Primary outcomes were feasibility (recruitment/retention) and user engagement metrics. Secondary clinical outcomes included pain intensity, fear-avoidance beliefs, kinesiophobia, and disability. RESULTS: The study demonstrated high feasibility with a 92% retention rate. Engagement analysis revealed heterogeneous usage patterns, consistent with a self-directed learning design. Regarding clinical outcomes, the intervention significantly prevented the deterioration of disability observed in the control group (MD -4.1; p = .023). No significant between-group differences were observed for pain intensity, although the experimental group showed significant within-group reductions in fear-avoidance beliefs and kinesiophobia. CONCLUSIONS: A gamified web-based pain neuroscience education intervention is feasible and acceptable for patients in primary care. While a 15-day dose was insufficient to reduce pain intensity, the intervention effectively prevented functional deterioration. Future definitive trials should implement longer durations (>4 weeks) to optimize clinical efficacy.