Culture-sensitive Pain Neuroscience Education: a means for wider pain therapy access   April 12th, 2021

​Pain Neuroscience Education (PNE) is a method of educating patients about the neurophysiology of pain. It aims to re-conceptualize pain from an indicator of damage to an interpretation of input signals by the brain and nervous system1. PNE involves using convenient and effective methods to teach people in pain about the biology and physiology of their pain experience, including processes such as normal biology of pain, pain modulation, pain matrix, peripheral and central sensitization, allodynia, and neuroplasticity 2,3. Presently, there is growing evidence for the value of PNE in decreasing pain, disability, fear-avoidance, pain catastrophization, movement restriction, and health care utilization in people struggling with pain 2,4,5.

In order to educate someone about any concept, there is a need to use familiar cases to aide better understanding. When I first came across pain education slides, I saw examples based on the use of sophisticated technological systems that may be understood only by people living in advanced environments. For example, a faulty pain system was akin to a malfunctioning washing machine, which is not readily available or known by many people in the developing parts of the world especially a number of countries on the African continent. Some items that utilized electricity were used to explain pain generation mechanisms (like threat-alarm), whereas many parts of Africa are still not connected with electricity. Another incompatible component of PNE teaching for the developing countries is the use of pain education leaflet that is given to patients to study at home. Literacy level in some African countries is as low as 50% or less 6, which means up to half of a certain population may not be able to benefit from such materials/leaflets. Internet based method are recently advocated for PNE delivery which will be inaccessible by majority of Africans as the continent is the least connected with internet. On a more general note, existing PNE materials also contain pictures, examples and metaphors that may not be appropriate for African population. Moreover, variations in culture, socioeconomic status, gender issues, and literacy levels are important when developing educational tools.7 Patients’ beliefs are also a core part of pain perception and response, because pain is influenced both by beliefs and the emotional significance attributed to it8, since pain beliefs/attitudes, and coping strategies differ among different cultures and ethnicities.9

Therefore, a universal PNE material may not serve all populations, rather a culture-sensitive approach to pain education maybe the appropriate solution. In our current research, we developed the first culture-sensitive PNE materials for African (Hausa) patients with chronic spinal pain (CSP) through a modified Delphi study (currently under review with Spine journal). The recruited experts were a combination of: (i) physiotherapists with experience in PNE or Hausa culture or managing Hausa-patients with CSP; and (ii) Hausa-patients with CSP. Our study is novel because   it led to the provision of home education material in an audio form that can be accessed by all patients (irrespective of literacy level) and generation of gender specific teaching materials to accommodate the gender peculiarities of many African culture. All pictures, examples and metaphors included were also adapted to suit the African culture.

We have also gone a step further by conducting a pilot randomized clinical trial (RCT), and the results of the trial indicated that the culture-sensitive PNE materials were feasible for use among Hausa population (CSP patients). The trial also showed promising preliminary results of their effectiveness on some selected patients’ outcomes. A full RCT using the developed materials is now desirable, which we intend to carry out in the near future.

Naziru Bashir Mukhtar

PhD student

Department of Rehabilitation Sciences

Ghent University, Belgium

2020  Pain in Motion


1. Lane E, Fritz JM, Greene T, Maddox D. The effectiveness of training physical therapists in pain neuroscience education on patient reported outcomes for patients with chronic spinal pain: a study protocol for a cluster randomized controlled trial. BMC Musculoskeletal Disorders 2018; 19(1): 386.

2. Louw A, Nijs J, Puentedura EJ. A clinical perspective on a pain neuroscience education approach to manual therapy. J Man Manip Ther 2017; 25(3): 160-8.

3. Moseley GL, Butler DS. Fifteen years of explaining pain: the past, present, and future. The Journal of Pain 2015; 16(9): 807-13.

4. Louw A, Diener I, Landers MR, Puentedura EJ. Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up. Spine 2014; 39(18): 1449-57.

5. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Theory Pract 2016; 32(5): 332-55.

6. UNESCO AP. Reaching the 2015 Literacy Target: Delivering on the promise. High Level International Round Table on Literacy, UNESCO, Paris 2012: 6-7.

7. Lasch KE, Wilkes G, Montuori LM, Chew P, Leonard C, Hilton S. Using focus group methods to develop multicultural cancer pain education materials. Pain management nursing : official journal of the American Society of Pain Management Nurses 2000; 1(4): 129-38.

8. Main CJ, Foster N, Buchbinder R. How important are back pain beliefs and expectations for satisfactory recovery from back pain? Best practice & research Clinical rheumatology 2010; 24(2): 205-17.

9. Orhan C, Van Looveren E, Cagnie B, Mukhtar NB, Lenoir D, Meeus M. Are pain beliefs, cognitions, and behaviors influenced by race, ethnicity, and culture in patients with chronic musculoskeletal pain: A systematic review. Pain physician 2018; 21(6): 541-58.