Use of pain neuroscience education, balance evaluation, and exercise for treating chronic pain with kinesiophobia: a narrative review with clinical recommendations

Front Public Health. 2026 Aug 18;14:1863881. doi: 10.3389/fpubh.2026.1863881. eCollection 2026.

ABSTRACT

BACKGROUND: Chronic pain affects approximately 20% of the global population. In primary care settings, chronic pain may account for up to 37.5% of weekly consultations. Most chronic pain is non-specific, complicating diagnosis and treatment. Kinesiophobia and movement avoidance may accompany chronic pain, necessitating a biopsychosocial approach to treatment. Pain neuroscience education and corrective exercise have been proposed as treatment strategies. This review aims to critically examine the relationships among kinesiophobia, movement avoidance, and chronic pain; assess the effectiveness of pain neuroscience education; and present a practical framework to guide diagnosis and treatment within integrated primary care.

METHODS: Literature searches in PubMed, PsycInfo, CINAHL, and Google Scholar utilized the search terms chronic pain, kinesiophobia, fear of movement, fear of falling, backache, arthritis, neuroscience education, neuroeducation, balance, and proprioception. Inclusion criteria included English language, peer-reviewed literature published over the past 10 years. Exclusion criteria included studies not published in English and gray literature.

RESULTS: Both kinesiophobia and movement avoidance were significantly correlated with non-specific chronic pain, particularly among older adults. However, the relationship between kinesiophobia and movement avoidance was not direct. Pain neuroscience education combined with strengthening exercises had a positive impact on chronic pain, movement avoidance, and kinesiophobia.

DISCUSSION: Based on their findings, authors collaborated on a treatment strategy for integrated primary care settings, focusing on patient engagement, pain neuroscience education, balance assessment, and corrective exercise. More research is needed to further explain relationships between chronic pain, kinesiophobia, and movement avoidance, and the best strategies for managing these conditions in primary care.

PMID:42683035 | PMC:PMC13531184 | DOI:10.3389/fpubh.2026.1863881