Effectiveness of Pain Neuroscience Education and Therapeutic Exercise in Adults with Musculoskeletal Pain: A Randomized Controlled Experimental Pilot Study

Background/Objectives: Chronic musculoskeletal pain is a common public health problem with substantial functional and socioeconomic impact. Pain neuroscience education (PNE) has been proposed as a complementary strategy to therapeutic exercise; however, the available evidence shows considerable methodological variability and a limited number of studies evaluating its added effect in real-world clinical settings. This study evaluated the effect of incorporating a structured PNE programme into a therapeutic exercise protocol on pain intensity, kinesiophobia, and muscle strength in patients with musculoskeletal pain. Methods: A randomized controlled pilot trial was conducted in patients with chronic musculoskeletal pain. Participants were assigned to an experimental group (exercise + PNE) or a control group (exercise only). Participants were adults with chronic musculoskeletal pain of at least three months’ duration, predominantly women, with pain located mainly in the lumbar region, followed by the neck, shoulder, and knee. The intervention lasted 8 weeks, and pain, kinesiophobia, and muscle strength were assessed before and after the intervention. Outcome comparisons were performed using intra- and intergroup non-parametric statistical analyses, with the significance level set at p < 0.05. Results: No significant between-group differences were observed in pain intensity. The group receiving PNE showed greater improvements in kinesiophobia and fear-avoidance beliefs. Both groups significantly improved muscle strength, with no differences between them. Mean attendance at the PNE sessions was 88.3%; 31 of the 38 randomized participants (81.6%) were included in the final analysis, and no adverse events were observed. Conclusions: No statistically significant additional effect of PNE was detected on pain intensity or muscle strength in this pilot sample, although it was associated with greater reductions in kinesiophobia and fear-avoidance beliefs. Larger studies are needed to confirm these findings.