Elaboration of a booklet for individuals with chronic pain

Mendez, Sandra Porciuncula; Sá, Katia Nunes; Araújo, Paula Carneiro Silva de; Oliveira, Iasmyn Adélia Victor Fernandes de; Gosling, Artur Padão; Baptista, Abrahão Fontes

doi:10.5935/1806-0013.20170103

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ORIGINAL ARTICLES • Rev. dor 18 (3) • Jul-Sep 2017 • https://doi.org/10.5935/1806-0013.20170103 copy

Elaboration of a booklet for individuals with chronic pain

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

Chronic pain is considered a public health problem. The best way to deal with it is still a challenge. However, socio-educational interventions have been recommended in national and international guidelines that deal with it. The objective of this study was to develop an educational booklet written in the Brazilian Portuguese language for people who face the problem of chronic pain.

METHODS:

This study on the development of a light technology was conducted in three phases: the narrative of the literature review to identify the appropriate content; the approach of target audience through structured interviews; and the elaboration of a booklet by professionals specialized in the treatment of chronic pain.

RESULTS:

The study resulted in the production of a booklet named “EducaDor,” ludically illustrated with 18 pages, divided into the following sections: 1. What is pain? 2. Acute pain: useful pain; 3. Chronic pain: the persistent pain; 4. Living with the pain; 5. False ideas about chronic pain, do not believe them; 6. Strategies to deal with the pain. Using plain language, the booklet provides data on neurophysiology and psychological and behavioral aspects related to chronic pain. The booklet can contribute to modifying misbeliefs about pain and bad behaviors, as well as to provide strategies to cope with chronic pain.

CONCLUSION:

This study has successfully developed a light health technology which offers inputs for socio-educational programs to handle chronic pain.

Keywords:
Chronic pain; Health education; Self-management

Categories	Subcategories
1. What is pain?	Meanings of painCauses of pain
2. Acute pain	Meanings of acute painProcessing of acute pain
3. Chronic pain	Meanings of chronic pain Processing of chronic pain The (co)existence with pain Associated factors Mistaken beliefs Strategies for tackling pain

Models	Themes	Guidance/Strategies	Main Results
Biomedical	Anatomy and biomechanics³²32 Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J. Can a patient educational book change behavior and reduce pain in chronic low back pain patients? Spine J. 2004;4(4):425-35. 33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47. 34 Hodselmans AP, Jaegers SM, Göeken LN. Short-term outcomes of a back school program for chronic low back pain. Arch Phys Med Rehabil. 2001;82(8):1099-105. 35 Shirado O, Ito T, Kikumoto T, Takeda N, Minami A, Strax TE. A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting. Spine (Phila Pa 1976). 2005;30(10):1219-25. 36 Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC Musculoskelet Disord. 2007;8:21. 37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800. 38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9. 39 Sadeghi-Abdollahi B, Eshaghi A, Hosseini SN, Ghahremani M, Davatchi F. The efficacy of Back School on chronic low back pain of workers of a pharmaceutical company in a Tehran Suburb. COPCORD stage II study. Int J Rheum Dis. 2012;15(2):144-53.^-⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.; Epidemiology and physiopathology of pain³³33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47.^,³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.^,³⁸38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9.^,⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.^,⁴¹41 Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil. 2010;24(1):26-36..	Correct posture and movements in daily activities³³33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47.^,³⁵35 Shirado O, Ito T, Kikumoto T, Takeda N, Minami A, Strax TE. A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting. Spine (Phila Pa 1976). 2005;30(10):1219-25. 36 Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC Musculoskelet Disord. 2007;8:21. 37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800. 38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9.^-³⁹39 Sadeghi-Abdollahi B, Eshaghi A, Hosseini SN, Ghahremani M, Davatchi F. The efficacy of Back School on chronic low back pain of workers of a pharmaceutical company in a Tehran Suburb. COPCORD stage II study. Int J Rheum Dis. 2012;15(2):144-53.^,⁴¹41 Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil. 2010;24(1):26-36.; Physical Exercise³³33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47.^,³⁴34 Hodselmans AP, Jaegers SM, Göeken LN. Short-term outcomes of a back school program for chronic low back pain. Arch Phys Med Rehabil. 2001;82(8):1099-105.^,³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.^,⁴¹41 Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil. 2010;24(1):26-36.; Stay active³⁵35 Shirado O, Ito T, Kikumoto T, Takeda N, Minami A, Strax TE. A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting. Spine (Phila Pa 1976). 2005;30(10):1219-25.^,³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.^,⁴¹41 Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil. 2010;24(1):26-36.;	Reduction of pain³²32 Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J. Can a patient educational book change behavior and reduce pain in chronic low back pain patients? Spine J. 2004;4(4):425-35.^,³³33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47.^,³⁵35 Shirado O, Ito T, Kikumoto T, Takeda N, Minami A, Strax TE. A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting. Spine (Phila Pa 1976). 2005;30(10):1219-25.^,³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800. 38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9. 39 Sadeghi-Abdollahi B, Eshaghi A, Hosseini SN, Ghahremani M, Davatchi F. The efficacy of Back School on chronic low back pain of workers of a pharmaceutical company in a Tehran Suburb. COPCORD stage II study. Int J Rheum Dis. 2012;15(2):144-53.^-⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.; Reduction of incapacity³⁴34 Hodselmans AP, Jaegers SM, Göeken LN. Short-term outcomes of a back school program for chronic low back pain. Arch Phys Med Rehabil. 2001;82(8):1099-105.^,³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.^,³⁸38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9.^,⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.; Improvement to quality of life³⁶36 Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC Musculoskelet Disord. 2007;8:21.; Awareness of the problem⁴²42 Abourazzak F, El Mansouri L, Huchet D, Lozac'hmeur R, Hajjaj-Hassouni N, Ingels A, et al. Long-term effects of therapeutic education for patients with rheumatoid arthritis. Jt Bone Spine. 2009;76(6):648-53.; Satisfaction⁴²42 Abourazzak F, El Mansouri L, Huchet D, Lozac'hmeur R, Hajjaj-Hassouni N, Ingels A, et al. Long-term effects of therapeutic education for patients with rheumatoid arthritis. Jt Bone Spine. 2009;76(6):648-53.; Improved spinal mobility⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.; Reduction of anxiety and depression³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.; Perceived Control³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.; Improved physical ability³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800..
	Management of pain⁴³43 Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain. 2011;27(3):248-57.^,⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.; Pharmaceuticals⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117.; Nutrition⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85. 50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.^-⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.; Sleep⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.; Anatomy and pathology⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.; Basic physiology of pain⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵⁴54 Steihaug S, Ahlsen B, Malterud K. From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain. Scand J Prim Health Care. 2001;19(4):249-54.^,⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.; Ergonomics⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.^,⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵⁴54 Steihaug S, Ahlsen B, Malterud K. From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain. Scand J Prim Health Care. 2001;19(4):249-54.^,⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.; Response to pain, management of stress and mental health, dysfunctional beliefs, poorly adaptive behaviours, and capacity to tackle pain⁴³43 Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain. 2011;27(3):248-57.^,⁴⁵45 Man AK, Chu MC, Chen PP, Ma M, Gin T. Clinical experience with a chronic pain management programme in Hong Kong Chinese patients. Hong Kong Med J. 2007;13(5):372-8.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.^,⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7..	Physical exercise⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.^,⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.; Encouragement of spontaneous movements⁵²52 Sorensen PH, Bendix T, Manniche C, Korsholm L, Lemvigh D, Indahl A. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord. 2010;11:212.; Acceptance of pain and use of relaxation during routine daily activities⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.; Stopping smoking⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.; Weight control⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117.; Mapping of the problem⁵²52 Sorensen PH, Bendix T, Manniche C, Korsholm L, Lemvigh D, Indahl A. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord. 2010;11:212.; Counselling sessions⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.; Principles of behavioral cognitive therapy⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117.^,⁵⁰50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71. 56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.^-⁵⁷57 Rundell SD, Davenport TE. Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report. J Orthop Sports Phys Ther. 2010;40(8):494-501.; Explanatory leaflets⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117.; Activity sheets⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.; Techniques for motivation and self-regulation⁴³43 Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain. 2011;27(3):248-57..	Reduction of intensity of pain⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.^,⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117. 49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85. 50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.^-⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.; Reduction of physical incapacity⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.^,⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85. 50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.^-⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.^,⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7. 57 Rundell SD, Davenport TE. Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report. J Orthop Sports Phys Ther. 2010;40(8):494-501.^-⁵⁸58 Coudeyre E, Givron P, Vanbiervliet W, Benaïm C, Hérisson C, Pelissier J, et al. [The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit]. Ann Readapt Med Phys. 2006;49(8):600-8. French.; Improvement in general health and quality of life (QoL)⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.^,⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.^,⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85.^,⁵⁰50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.; Improvement to self-efficiency and strategies for management and tackling of pain⁴³43 Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain. 2011;27(3):248-57.^,⁵⁰50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.^,⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.; Reduction of catastrophism and poorly adaptive beliefs⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁵²52 Sorensen PH, Bendix T, Manniche C, Korsholm L, Lemvigh D, Indahl A. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord. 2010;11:212.; Reduction of symptoms showing depression and anxiety⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.^,⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.;Improved awareness⁴³43 Meng K, Seekatz B, Roband H, Worringen U, Vogel H, Faller H. Intermediate and long-term effects of a standardized back school for inpatient orthopedic rehabilitation on illness knowledge and self-management behaviors: a randomized controlled trial. Clin J Pain. 2011;27(3):248-57.^,⁵⁸58 Coudeyre E, Givron P, Vanbiervliet W, Benaïm C, Hérisson C, Pelissier J, et al. [The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit]. Ann Readapt Med Phys. 2006;49(8):600-8. French.; Satisfaction⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.^,⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.^,⁵⁸58 Coudeyre E, Givron P, Vanbiervliet W, Benaïm C, Hérisson C, Pelissier J, et al. [The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit]. Ann Readapt Med Phys. 2006;49(8):600-8. French.; Reduction of health expenses⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.^,⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.; Increased rate of return to work⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7..
Neurophysiology of pain	Characteristics, purpose, and processing of acute pain, and processing and sustenance factors for chronic pain, including emotions, stress, cognition, and behaviour¹⁶16 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8(1):39-45.^,⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302.^,⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82. 61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62. 62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7. 63 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30. 64 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52. 65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.^-⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58..	Use of illustrations, examples and metaphors⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.^,⁶⁴64 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52.^,⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.; Exercise booklets for home⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302.^,⁶³63 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30.; Pain log book⁶⁴64 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52.; Informative leaflet⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82.^,⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.; Questionnaire on the neurophysiology of pain⁶⁵65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.^,⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.; Practice of exercises⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62..	Pain education⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302. 60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82. 61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.^-⁶²62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.; Greater tolerance to pain⁶²62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.^,⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.; Reduction of incapacity⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.; Normalization of attitudes and beliefs with regard to pain¹⁶16 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8(1):39-45.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62. 62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.^-⁶³63 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30.; Improvement in vitality and mental health⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82.; Reduction of catastrophism¹⁶16 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8(1):39-45.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62. 62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.^-⁶³63 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30.^,⁶⁵65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.; Improvement to physical performance⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82.^,⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.^,⁶⁵65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.^,⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.; Increased awareness about the biology of pain⁶⁵65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.; Reduction of concern about pain in the short term⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82.; Improved endogenous inhibition⁶⁰60 Van Oosterwijck J, Meeus M, Paul L, De Schryver M, Pascal A, Lambrecht L, et al. Pain physiology education improves health status and endogenous pain inhibition in fibromyalgia: A double-blind randomized controlled trial. J Pain. 2013;29(10):873-82.; Changes to brain activities⁶⁴64 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52..

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[1] Correspondence to: UFABC - Alameda da Universidade, s/n - Anchieta 09606-045 São Bernardo do Campo, SP, Brasil. E-mail: abrahao.baptista@gmail.com

Biomedical model
	Population	Intervention/comparison	Follow-up measures	Results
Udermann et al.³²32 Udermann BE, Spratt KF, Donelson RG, Mayer J, Graves JE, Tillotson J. Can a patient educational book change behavior and reduce pain in chronic low back pain patients? Spine J. 2004;4(4):425-35.	I n d i v i d u a l s with chronic low back pain	They received a copy of an educative book, written examination of its content, and two interviews by telephone.	Intensity of pain, episodes of pain, self-care behaviors, knowledge and opinion on the book.	Improvement in pain, in the understanding of the content and opinions on the text were positive in general. In 9 months of follow-up: significant improvement in pain, number of episodes and perceived benefit. After 18 months of follow-up, these benefits were maintained or have further improved.
Garcia et al.³³33 Garcia AN, Costa Lda C, da Silva TM, Gondo FL, Cyrillo FN, Costa RA, et al. Effectiveness of back school versus Mckenzie exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Phys Ther. 2013;93(6):729-47.	Individuals with chronic low back painnon-specific	Back school in groups / McKenzie individually. Both performed a set of daily exercises at home.	Pain intensity (visual analog scale (VAS)), disability (Roland-Morris), trunk flexion movement, quality of life (BREF)	The McKenzie method was slightly more effective than the Back school method for disability, but not for pain intensity immediately after the treatment. There was no untreated control group.
Hodselmans, Jaegers and Göeken³⁴34 Hodselmans AP, Jaegers SM, Göeken LN. Short-term outcomes of a back school program for chronic low back pain. Arch Phys Med Rehabil. 2001;82(8):1099-105.	I n d i v i d u a l s with chronic low back pain	IG (intervention group): Back school program - somatic cognitive CG (control group): waiting list	Physical function and disability (RAND-36), ROM of the lumbar region,	The IG had a significant improvement in the functional status and perceived disability, probably attributable to appropriate perceptions of the physical symptoms.
Shirado et al³⁵35 Shirado O, Ito T, Kikumoto T, Takeda N, Minami A, Strax TE. A novel back school using a multidisciplinary team approach featuring quantitative functional evaluation and therapeutic exercises for patients with chronic low back pain: the Japanese experience in the general setting. Spine (Phila Pa 1976). 2005;30(10):1219-25.	I n d i v i d u a l s with chronic low back pain	Phase 1. A program run by an interdisciplinary team performed in groups with a 3-hour duration.	Pain intensity (VAS), the flexibility of the trunk and hamstrings (finger-floor distance, leg elevation), muscle strength and trunk endurance, and patient satisfaction.	The result was considered satisfactory for the treatment of patients with chronic low back pain. Teaching the mechanics of the body and perform therapeutic exercises, through a multidisciplinary team approach is essential for the management of chronic low back pain.
Tavafian et al.³⁶36 Tavafian SS, Jamshidi A, Mohammad K, Montazeri A. Low back pain education and short term quality of life: a randomized trial. BMC Musculoskelet Disord. 2007;8:21.	Women with chronic low back pain	Groups 1 and 2 were assessed and received treatment. Group 1 participated in the Back school program	Short Form Health Survey (SF-36)	The Back School" program was effective in the improvement of the quality of life of the patients. In the G2, the improvement was observed in three domains (pain, vitality and mental health), but these improvements were smaller than in G1.
Gaskell, Enright and Tyson³⁷37 Gaskell L, Enright S, Tyson S. The effects of a back rehabilitation programme for patients with chronic low back pain. J Eval Clin Pract. 2007;13(5):795-800.	I n d i v i d u a l s with non-specific chronic low back pain	Nine group sessions of 2 hours each over 5 weeks.	Pain (VAS), disability (Roland Morris), anxiety and depression (HADS), perception of pain control, Fitness test and a 5-minute walking test	Levels of pain, disability, anxiety, and depression were significantly reduced. Fitness levels and perceived control improved significantly, suggesting that participants were more able to manage their low back pain. Limitations: There was no control group, and there was a high drop-out rate during the study.
Cecchi et al⁴¹41 Cecchi F, Molino-Lova R, Chiti M, Pasquini G, Paperini A, Conti AA, et al. Spinal manipulation compared with back school and with individually delivered physiotherapy for the treatment of chronic low back pain: a randomized trial with one-year follow-up. Clin Rehabil. 2010;24(1):26-36.	Women with non-specific chronic low back pain	Back school, individual physiotherapy, and manipulation. All participants received a booklet with information about the anatomy and biomechanics of the spine, posture and ergonomics guidelines.	Disability Roland Morris Disability Questionnaire) and pain (Pain Rating Scale).	Spinal manipulation was better associated with functional improvement and long-term pain relief than back school or individual physiotherapy but received more additional treatment during the follow-up. Pain recurrences and drug consumption were also reduced in comparison to back school or individual therapy.
Sahinet al.³⁸38 Sahin N, Albayrak I, Durmus B, Ugurlu H. Effectiveness of back school for treatment of pain and functional disability in patients with chronic low back pain: a randomized controlled trial. J Rehabil Med. 2011;43(3):224-9.	I n d i v i d u a l s with chronic low back pain	IG: performed exercises, physical treatment modalities, and a back school program.CG: performed exercises and received physical treatment modalities.	Pain intensity (VAS) and functionality (Oswestry Low Back Pain Disability Questionnaire)	Improvement in pain and functionality in both groups, but the difference between the scores at the end of the treatment and after 3 months of treatment was not significant.
Sadeghi-Abdollahi et al.³⁹39 Sadeghi-Abdollahi B, Eshaghi A, Hosseini SN, Ghahremani M, Davatchi F. The efficacy of Back School on chronic low back pain of workers of a pharmaceutical company in a Tehran Suburb. COPCORD stage II study. Int J Rheum Dis. 2012;15(2):144-53.	Workers with chronic lower back pain	Back school Program	Pain intensity (VAS); quality of life (Short Form (SF-36).	Improvement, but not significant, of pain intensity. Three months after the end of the sessions, improvement became significant. No improvement in the quality of life was observed.
Andrade et al.⁴⁰40 Andrade SC, Araújo AG, Vilar MJ. Escola de coluna para pacientes com lombalgia crônica inespecífica: benefícios da associação de exercícios e educação ao paciente. Acta Reumatol Port. 2008;33(4):443-50.	I n d i v i d u a l s with chronic low back pain	IG: Theoretical and practical program of the Escola de coluna (Spine School).CG: waiting list.	Pain intensity (VAS), functional capacity (Roland-Morris) and lumbar spine mobility (Schöber index).	Statistically significant improvement in pain intensity of pain, functional capacity and mobility of the lumbar spine in IG. A statistically significant difference was observed intragroup in the second and third assessments of the functional capacity and mobility variables of the lumbar spine.
Abourazzak et al.⁴²42 Abourazzak F, El Mansouri L, Huchet D, Lozac'hmeur R, Hajjaj-Hassouni N, Ingels A, et al. Long-term effects of therapeutic education for patients with rheumatoid arthritis. Jt Bone Spine. 2009;76(6):648-53.	Individuals withrheumatoid arthritis	Theoretical and practical education program	Knowledge of AR (self-questionnaire), disease activity (DAS 28), functional capacity (HAQ) and quality of life	Patient's knowledge 3 years after the education program has significantly improved. Disease activity was significantly lower in the education group after 3 years than at the beginning of the study.
Biopsychosocial Model
	Population	Intervention/comparison	Follow-up measures	Results
Pieber et al.⁴⁹49 Pieber K, Herceg M, Quittan M, Csapo R, Müller R, Wiesinger GF. Long-term effects of an outpatient rehabilitation program in patients with chronic recurrent low back pain. Eur Spine J. 2014;23(4):779-85.	I n d i v i d u a l s with chronic low back pain	Program: 40 sessions including endurance training, psychological interventions, ergonomics sessions and healthy eating habits.	Painless ROM, the strength of the spinal extensor muscles, pain (VAS), disability (Roland-Morris) and quality of life (SF-36).	All measurements improved significantly in the post-rehab assessment and remained in the 18 months after the intervention.There was no control group.
Buchner et al.⁵⁶56 Buchner M, Zahlten-Hinguranage A, Schiltenwolf M, Neubauer E. Therapy outcome after multidisciplinary treatment for chronic neck and chronic low back pain: a prospective clinical study in 365 patients. Scand J Rheumatol. 2006;35(5):363-7.	Individuals with cervicalgia or chronic low back pain.	Multidisciplinary bio psychosocial therapy during 3 weeks of internment and 6 months of follow-up.	Return to the work, Quality of life (SF-36), pain intensity (VAS), functional capacity (Hannover back capacity score), and satisfaction with the therapy.	Both treatment groups had significantly improved all criteria. At the end of the follow-up period, there were no significant differences between the group with chronic neck pain and chronic back pain regarding the criteria to return to work, improvement in the quality of life, functional capacity, satisfaction with the therapy and pain reduction.
Morone et al.⁴⁶46 Morone G, Paolucci M, Alcuri M, Vulpiani M, Matano A, Bureca I, et al. Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial. Eur J Phys Rehabil Med. 2011;47(4):533-41.	Patients with chronic low back pain	IG: Back school: Brief education and active exercises for the spine. CG: medical care. The medication was the same in both groups.	Pain intensity (VAS) quality of life (SF36) and disability (Oswestry Disability Index).	Quality of life and disability have significantly improved over time in the IG. The result of the perception of pain showed a reduction in both groups but was significantly lower in the IG at the end of the treatment and the two follow-ups.
Sorensen et al.⁵²52 Sorensen PH, Bendix T, Manniche C, Korsholm L, Lemvigh D, Indahl A. An educational approach based on a non-injury model compared with individual symptom-based physical training in chronic LBP. A pragmatic, randomised trial with a one-year follow-up. BMC Musculoskelet Disord. 2010;11:212.	I n d i v i d u a l s with chronic low back pain	Educational program/ individual physical training program based on the symptoms.	Pain (Numerical Rating Scale), disability (Roland Morris), attitudes facing pain Fear-Avoidance Beliefs Questionnaire and Back Beliefs Questionnaire, quality of life, sick leave, use of medical services.	There was an improvement in disability and also in the beliefs of fear and avoidance in the education group. All the other variables were almost equally influenced by the two treatments
Rundelle Davenport⁵⁷57 Rundell SD, Davenport TE. Patient education based on principles of cognitive behavioral therapy for a patient with persistent low back pain: a case report. J Orthop Sports Phys Ther. 2010;40(8):494-501.	70-year old woman with chronic low back pain.	Patient education based on the cognitive-behavioral theory.	Disability (Oswestry Disability Questionnaire), beliefs about pain (Fear-Avoidance Belief Questionnaire), symptoms of depression (Beck Depression Index) and self-efficacy (The Low Back Activity Confidence Scale).	Improvement in disability, fear-avoidance behaviors, depressive symptoms, and self-efficacy.
Coudeyre et al.⁵⁸58 Coudeyre E, Givron P, Vanbiervliet W, Benaïm C, Hérisson C, Pelissier J, et al. [The role of an information booklet or oral information about back pain in reducing disability and fear-avoidance beliefs among patients with subacute and chronic low back pain. A randomized controlled trial in a rehabilitation unit]. Ann Readapt Med Phys. 2006;49(8):600-8. French.	Patients with subacute or chronic low back pain	IG: Back book and frequent physiotherapy.CG: frequent physical therapy along with non-standard oral information (restricted to the questions asked by patients)	Satisfaction, functional capacity; pain intensity (VAS), beliefs of fear and avoidance (Fear-Avoidance Questionnaire) and knowledge.	Receiving the "back book" had a significant impact on disability within 3 months, and also had a significant impact on the patients' knowledge and satisfaction, but little effect on the beliefs of fear and avoidance.
Wu et al.⁵³53 Wu SF, Kao MJ, Wu MP, Tsai MW, Chang WW. Effects of an osteoarthritis self-management programme. J Adv Nurs. 2011;67(7):1491-501.	Individuals with knee osteoarthritis	The program provided information about osteoarthritis and coping skills.	Arthritis Self-efficacy Scale (ASE); The Survey of Pain Attitude (SOPA-35), consultations with healthcare professionals, number of days with pain and disability.	Significant differences were found in the beliefs of pain and days with pain after the intervention. After 8 weeks, there has been a significant improvement in self-efficacy, pain episodes and number of unplanned medical visits.
Coleman et al.⁴⁸48 Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J. Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskelet Disord. 2008;9:117.	Patients with osteoarthritis	Specific self-management educational program together with written material.	Pain, physical function and mental health scales (WOMAC and SF-36)	There was an improvement in pain, function and mental health indexes.
Goeppinger et al.⁵⁰50 Goeppinger J, Armstrong B, Schwartz T, Ensley D, Brady TJ. Self-management education for persons with arthritis: Managing comorbidity and eliminating health disparities. Arthritis Care Res. 2007;57(6):1081-8.	Patients with osteoarthritis	Specific intervention for people with arthritis (Arthritis Self-Help Course - ASHC) and other generic, Chronic Disease Self-Management Program (CDSMP).	Quality of life, self-management behaviors and self-efficacy for arthritis.	The ASHC group showed significant improvement in self-efficacy, stretching and muscle strengthening and general health. The CDSMP group showed significant improvement in self-efficacy, disability, pain, and general health. The CDSMP group produced better results.
Watson, Cosioe Lin⁴⁷47 Watson EC, Cosio D, Lin EH. Mixed-method approach to veteran satisfaction with pain education. J Rehabil Res Dev. 2014;51(3):503-14.	Veterans with chronic idiopathic pain.	Classrooms Back School + handouts	Opinion, satisfaction and overall effectiveness of the program survey.	Participants reported learning new and useful "information", they considered the program "easy to understand", used the information learned, and recommended the program to others.
Salvetti et al.⁵¹51 Salvetti Mde G, Cobelo A, Vernalha Pde M, Vianna CI, Canarezi LC, Calegare RG. [Effects of a psychoeducational program for chronic pain management]. Rev Lat Am Enfermagem. 2012;20(5):896-902. English, Portuguese, Spanish.	Individuals with chronic pain due to different diseases	A program that included physical exercises, psycho-educational group, sessions with an occupational therapist and a nutritionist.	Pain (VAS), disability (Oswestry Disability Index and Beck's Depression Inventory.	It was observed a significant reduction in pain intensity, disability, and depressive symptoms. These effects remained for a 6-month period.
Steihaug, Ahlsene Malterud⁵⁴54 Steihaug S, Ahlsen B, Malterud K. From exercise and education to movement and interaction. Treatment groups in primary care for women with chronic muscular pain. Scand J Prim Health Care. 2001;19(4):249-54.	Women with chronic muscle pain	From education to interaction: Eight treatment groups, each with 12 weeks duration, and three groups with 10 months duration.	Qualitative data analysis from field notes, focus groups, training videos, and discussion groups.	The training program is now focused on some simple exercises and is characterized by the awareness of the relationship between breathing and muscle tension. The groups become the main pillar of the program, characterized by safety and a feeling of belonging, reflection, and development.
Man et al.⁴⁵45 Man AK, Chu MC, Chen PP, Ma M, Gin T. Clinical experience with a chronic pain management programme in Hong Kong Chinese patients. Hong Kong Med J. 2007;13(5):372-8.	Patients with chronic pain	A program that includes education on pain, training in communication skills and coping strategies, physical exercises and functional activities.	Pain, catastrophism, self-efficacy, functional capacity and use of drugs.	Improvement in pain, quality of life, catastrophization, self-efficacy, functional capacity and improvement in employment rate.
Thorn et al.⁴⁴44 Thorn BE, Day MA, Burns J, Kuhajda MC, Gaskins SW, Sweeney K, et al. Randomized trial of group cognitive behavioral therapy compared with a pain education control for low-literacy rural people with chronic pain. Pain. 2011;152(12):2710-20.	Heterogeneous group with chronic pain.Rural area	Cognitive behavioral therapy (CBT): addressed thoughts and feelings in response to pain and stress. Education (EDU): addressed facts about the body, pain, and learning.	Pain intensity (Wisconsin Brief Pain Inventory), disability (Roland-Morris),catastrophism, depression, satisfaction, and quality of life.	Patients in both conditions reported significant improvement in all results related to pain. A non-significant trend was found for depressive mood with better improvement in CBT than EDU. Treatment gains were kept at 6 months of follow-up.
Quintneret al.⁵⁵55 Quintner J, Bs MB, Parkitny L, Physio B, Painmgt MS, Knight P, et al. Preclinic group education sessions reduce waiting times and costs at public pain. Pain Med. 2011;12:59-71.	People with persistent pain.	Educational workshops Self-Training (STEPS): group educational program for 8 hours during two days, followed by optional medical visits initiated by the patient.	The number of patients who completed, costs per new patient, use of health care, perceived changes and pain management strategies.	The introduction of STEPS was associated with the reduction of public health services costs, increased use of pain management strategies and patient satisfaction.
Combined model - Neurophysiology
	Population	Intervention/comparison	Follow-up measures	Results
Moseley⁵⁹59 Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother. 2002;48(4):297-302.	Patients with chronic low back pain	Weekly, each patient had two physiotherapy sessions and one individual educational session on the neurophysiology of pain for four weeks.	Pain and disability (numeric pain scale and Roland Morris Questionnaire)	The physiotherapy program reduced pain and disability, and the effect of the treatment remained for one year.
Moseley¹⁶16 Moseley GL. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chronic low back pain. Eur J Pain. 2004;8(1):39-45.	Patients with chronic low back pain	An individual educational session on the lumbar spine and pain physiology.	Attitudes facing pain (SOPA), catastrophism (PCS) and physical performance.	There was a strong relationship between cognitive change and change in physical performance, mainly explained by the change in the catastrophic belief that pain means tissue damage.
Van Oosterwijcket al.⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.	Patients with whiplash-associated chronic diseases.	Two educational sessions of 30 minutes each and a leaflet on the neurophysiology of pain.	Pain, kinesophobia, attitudes vis-à-vis the pain, cervical extension test, and brachial plexus test.	A significant decrease in kinesophobia and passive coping strategies.
Van Oosterwijcket al.⁶⁶66 Van Oosterwijck J, Nijs J, Meeus M, Truijen S, Craps J, Van den Keybus N, et al. Pain neurophysiology education improves cognitions, pain thresholds, and movement performance in people with chronic whiplash: a pilot study. J Rehabil Res Dev. 2011;48(1):43-58.	Patients with fibromyalgia	IG: Education on the physiology of pain CG: selfmanagement	Effectiveness of the inhibitory mechanism of pain, pressure pain threshold and questionnaires to assess pain cognitions, behavior, and health.	IG: improvement in the knowledge of pain neurophysiology, less concern with their short-term pain. Long-term improvements were observed in physical functioning, vitality, mental health and general health. In addition, the IG reported lower levels of pain and improvement of endogenous pain inhibition in comparison with the control group.
Ryan et al.⁶²62 Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Man Ther. 2010;15(4):382-7.	Individuals with chronic low back pain	Education in the biology of pain and group exercise classes (EDEX) and pain biology learning in a single group (ED)	Pain (numerical scale) and disability Roland Morris), self-efficacy, tests of physical performance and monitoring of activities in daily life.	More favorable results in the ED group. In the short term, the teaching of the biology of pain was more effective than the combination of teaching the biology of pain and group exercise classes.
Louw, Puentedura and Mintken⁶¹61 Louw A, Puentedura EL, Mintken P. Use of an abbreviated neuroscience education approach in the treatment of chronic low back pain: a case report. Physiother Theory Pract. 2012;28(1):50-62.	Individuals with chronic low back pain	Education in neuroscience; and refresher training before and during exercises and water therapy.	Pain (VAS), beliefs and fears facing pain (Fear Avoidance); depression (Zung Depression Scale) and disability (Oswestry Disability Index)	One patient reported improvement in the four measures, mainly in the beliefs and behaviors facing pain. In a 7-month follow-up, all the measures continued to improve.
Moseley, Nicholas and Hodges⁶³63 Moseley GL, Nicholas MK, Hodges PW. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Clin J Pain. 2004;20(5):324-30.	Individuals with chronic low back pain	IG: one individual session on the neurophysiology of pain. CG: a class on anatomy and physiology of the spine.At the end of the session, each participant received an exercise book with 10 sections.	Attitudes facing pain (SOUP); catastrophism (Pain Catastrophizing Scale); disability Roland Morris; physical performance tasks.	In the IG, it was observed a normalization in the attitudes and beliefs regarding pain, a reduction of the catastrophism and an improvement in the physical performance. Patients were less likely to seek care from other people, more likely to believe that they could control their own pain, that pain is influenced by emotional states, less likely to believe that pain is an indication of tissue damage, and perceived themselves as less disabled.
Moseley⁶⁴64 Moseley GL. Widespread brain activity during an abdominal task markedly reduced after pain physiology education: fMRI evaluation of a single patient with chronic low back pain. Aust J Physiother. 2005;51(1):49-52.	Case Study. A 36-year-old woman with chronic back pain.	Education in the physiology of pain: The initial physiotherapy session aimed at teaching the patient how to perform a task. Daily practice	McGill Pain Questionnaire, Roland Morris Questionnaire, Fear Avoidance Questionnaire and self-efficacy pain questionnaire.	A sharp reduction in cortical activation in areas usually involved in pain. Education on pain physiology can be an effective strategy to overcome the barriers to acquire normal trunk muscle control in patients with low back pain _
Gallagher, McAuleye Moseley⁶⁵65 Gallagher L, McAuley J, Moseley GL. A Randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain. The Clin J Pain. 2013;29(1):20-5.		Protocol: Two interventions, both using a booklet.Booklet 1 (IG): Metaphors and stories to help understand the biology of pain and concepts about pain management. Booklet 2 (CG): Advice on handling pain.	Questionnaire about pain biology, catastrophism, pain, and disability.	An increase of knowledge on the biology of pain in IG, but not in the CG. Higher reduction of catastrophic thoughts related to pain in IG than in the CG.Although both groups have improved over time, there was no differential effect on pain and disability.