Limited perceived value of pain science education among people with persistent pain reporting no improvement: A mixed-methods secondary analysis

J Pain. 2026 Apr 25:106304. doi: 10.1016/j.jpain.2026.106304. Online ahead of print.

ABSTRACT

Pain science education (PSE) aims to shift unhelpful beliefs about pain and improve clinical outcomes. However, some people report little improvement after receiving PSE-informed care. Understanding their perspectives may help refine educational delivery. We conducted a convergent mixed-methods analysis of survey data from adults with persistent pain who self-identified as 'not improved' following individual PSE-informed care (n=19). Quantitative data captured perceived importance of 11 predefined pain concepts using a 6-point Likert scale (from "very important" to "I don't know what this means"). Qualitative free-text responses described participants' most important pain concepts. Thematic analysis and descriptive statistics were integrated in a joint display to identify convergence and divergence across data strands. Most participants were female (58%), aged 35-55 years (69%) and living with pain for more than five years (79%). Except for "all pain is real," which 68% rated as very important, most target concepts were rated as unimportant or unclear. Qualitative themes described seeking a clear diagnosis, accepting pain as unchangeable, finding trusted clinicians, and pursuing biologically-based and individually tailored treatments, while rejecting notions that their beliefs or learning about pain could change their pain. Limited valuing of PSE concepts among non-improvers may reflect disrupted trust and validation within clinician-patient relationships, as well as messages that felt implausible or dismissive of lived experience. Strengthening relational foundations and co-designing clearer, affirming educational messages may enhance engagement with PSE among people with persistent pain.

PERSPECTIVE: This article presents a mixed-methods analysis that found that people whose persistent pain did not improve after pain science education placed limited value on many target concepts. Findings can help improve delivery of this intervention.

PMID:42044822 | DOI:10.1016/j.jpain.2026.106304