# Pain Neuroscience Education in Children and Adolescents with Chronic Pain: A Systematic Review

## TL;DR

Pain neuroscience education helps children and teens with chronic pain understand their condition better and improves their ability to cope, but effects on emotions and pain levels are small and short-term.

## Contribution

This is the first systematic review to evaluate the effectiveness of pain neuroscience education specifically in children and adolescents with chronic pain.

## Key findings

- Pain neuroscience education improves pain understanding, functionality, and self-efficacy in children and adolescents.
- Effects on emotional variables like anxiety and kinesiophobia are modest and short-lived.
- Combining PNE with exercise and digital formats may enhance effectiveness and reach.

## Abstract

What are the main findings?
Pain neuroscience education improves pain understanding, functionality, and self-efficacy in children and adolescents with chronic pain.Pain neuroscience education also influences emotional variables such as anxiety, catastrophizing, and kinesiophobia, although effects are often modest and short-lived.

Pain neuroscience education improves pain understanding, functionality, and self-efficacy in children and adolescents with chronic pain.

Pain neuroscience education also influences emotional variables such as anxiety, catastrophizing, and kinesiophobia, although effects are often modest and short-lived.

What is the implication of the main finding?
Combining pain neuroscience education with physical exercise and implementing school- or digital-based delivery formats may enhance effectiveness and broaden the reach of interventions.Including parents and caregivers in pain neuroscience education programs could improve clinical outcomes and support a more comprehensive and sustainable approach to pediatric chronic pain.

Combining pain neuroscience education with physical exercise and implementing school- or digital-based delivery formats may enhance effectiveness and broaden the reach of interventions.

Including parents and caregivers in pain neuroscience education programs could improve clinical outcomes and support a more comprehensive and sustainable approach to pediatric chronic pain.

Background/Objectives: Pain neuroscience education (PNE) has demonstrated efficacy in adults with chronic pain, but the pediatric evidence is still developing, despite its increasingly frequent use. Evidence for the effectiveness of PNE in pediatrics remains fragmented across settings and outcomes, which justifies a systematic evaluation focused on children and adolescents. Methods: Following PRISMA, two reviewers independently screened records (PubMed, Web of Science, PEDro; through 21 July 2025), extracted data, and assessed risk of bias (RoB 2 for randomized controlled trials; NIH/CASP for non-randomized studies). Given the heterogeneity, we conducted a structured narrative synthesis (SWiM) and rated the certainty of evidence with GRADE. PROSPERO: CRD420251062922. Results: Eleven studies met the inclusion criteria. PNE consistently improved pain-related knowledge, with effects maintained at follow-up (moderate certainty); effects on pain intensity, function, and emotional outcomes were small and inconsistent (low certainty), with more favorable patterns when PNE was combined with exercise and/or booster sessions. Digital and gamified formats proved feasible and engaging; parental outcomes showed small improvements where measured. Conclusions: PNE is a promising, low-cost, and scalable component of pediatric chronic pain care, strengthening self-efficacy and adaptive coping. Integration into biopsychosocial, multidisciplinary programs—particularly alongside exercise and family involvement—may optimize outcomes. Larger, standardized trials with long-term follow-up and systematic adverse-event reporting are needed to solidify guidance for clinical practice.