Physiotherapists’ Experiences and Needs Regarding Pain Neuroscience Education in Switzerland: An Online Survey

Abstract

Background

Almost 30 % of the population is affected by pain lasting longer than three months, and, out of those, every fourth person is in physiotherapeutic care. Pain Neuroscience Education (PNE) is an effective and low-priced tool for managing pain, wherein patients get taught about the neuroscience of pain, thus shifting their perspective. However, no studies have yet investigated whether physiotherapists actively integrate PNE into their practice in Switzerland, or whether there are unmet needs regarding PNE materials.

Aim

Answer the research questions: Do Swiss physiotherapists know of and use PNE? What are limitations to the usage of PNE, and do physiotherapists have unmet needs regarding PNE materials?

Methods

In this cross-sectional study, an online survey investigating the topic was sent to Swiss physiotherapists. Quantitative data were analysed using inferential statistics, and qualitative data using reflexive thematic analysis.

Results

Of the n = 358 participants, 61.5 % knew of PNE, 51.7 % utilised it, but only 39.4 % felt confident in applying it in their practice. The limitations most mentioned to usage were time and language barriers, while 24.0 % felt that they did not know PNE well enough. Indeed, only 21.0 % of the participants were taught PNE during their undergraduate studies, and specialised literature was only known to a fraction. Some felt new materials were needed, and the need for materials in a variety of languages was highlighted. Bridging the gap between knowing the neurophysiology of pain and teaching it to patients was an issue raised by several participants.

Conclusions

Most physiotherapists of this sample in Switzerland know of PNE, but only a minority confidently utilises it in practice. Utilisation is limited by time constraints and language barriers and therapists struggle to transfer knowledge into practice. It is unclear whether new materials are needed, but techniques to teach patients definitely seem to be important.

Zusammenfassung

Hintergrund

Knapp 30 % der Bevölkerung sind von Schmerzen betroffen, die länger als 3 Monate andauern, davon wird jede vierte Person mit Physiotherapie behandelt. Pain Neuroscience Education (PNE) ist eine effektive und kostengünstige Therapiemaßnahme im Schmerzmanagement. Dabei wird Patient*innen die Neurophysiologie des Schmerzes erklärt, um deren Sichtweise darauf zu verändern. Es wurde bisher jedoch nicht untersucht, ob in der Schweiz PNE in der Physiotherapie angewendet wird, und es noch Bedürfnisse bezüglich PNE-Materialien gibt.

Ziel

Beantwortung der Forschungsfragen: Kennen Schweizer Physiotherapeut*innen PNE und wenden sie es an? Welche Limitationen gibt es hierbei und haben sie Bedürfnisse hinsichtlich PNE-Materialien?

Methoden

In dieser Querschnittsstudie wurde eine Online-Befragung zu diesem Thema an Physiotherapeut*innen in der Schweiz versendet. Quantitative Daten wurden mittels Interferenzstatistik und qualitative Daten mit Reflexive Thematic Analysis ausgewertet.

Ergebnisse

Von den n = 358 Teilnehmenden (TN) kannten 61,5 % PNE, 51,7 % wendeten es an, aber nur 39,4 % fühlten sich sicher in der Anwendung. Limitiert wurde die Anwendung durch Zeitmangel und Sprachbarrieren. Auch fühlten sich 24,0 % bei der Anwendung eingeschränkt, weil sie zu wenig über PNE wussten. Tatsächlich kannten nur 21,0 % der Teilnehmenden PNE aus der Grundausbildung, entsprechende Fachliteratur war nur wenigen bekannt. Manche TN berichteten Bedarf an weiteren PNE-Materialien, ebenso wie die Notwendigkeit für Materialien in verschiedenen Sprachen. Viele TN hatten Schwierigkeiten damit, das vorhandene neurophysiologische Wissen Patient*innen zu vermitteln.

Schlussfolgerungen

Die meisten Schweizer Physiotherapeut*innen, die an der Studie teilnahmen, kennen PNE, aber nur eine Minderheit fühlt sich sicher bei der Anwendung. Die Anwendung wird limitiert durch Zeitmangel, Sprachbarrieren und Probleme, das Erlernte in die Praxis umzusetzen. Es ist unklar, ob neue Materialien benötigt werden, aber Techniken für die Anwendung zu vermitteln erscheint definitiv wichtig.

Key words

pain - pain neuroscience education - physiotherapy - chronic pain - undergraduate

Schlüsselwörter

Schmerz - Pain Neuroscience Education - Physiotherapie - Chronische Schmerzen - Grundausbildung

Publication History

Received: 30 January 2025

Accepted: 26 June 2025

Article published online:
01 September 2025

• References

• 1 St Sauver JL, Warner DO, Yawn BP. et al. Why Patients Visit Their Doctors: Assessing the Most Prevalent Conditions in a Defined American Population. Mayo Clinic Proceedings 2013; 88: 56-67
• 2 Cohen SP, Vase L, Hooten WM. Chronic pain: an update on burden, best practices, and new advances. The Lancet 2021; 397: 2082-2097
• 3 Oggier W. Volkswirtschaftliche Kosten von chronischen Schmerzen in der Schweiz/eine erste Annäherung. Schweizerische Ärztezeitung 2007; 88: 1265-1269
• 4 Treede R-D, Rief W, Barke A. et al. A classification of chronic pain for ICD-11. Pain 2015; 156: 1003-1007
• 5 Barker C, Taylor A, Johnson M. Problematic pain – redefining how we view pain?. Brit J Pain 2014; 8: 9-15
• 6 Van Griensven H, Strong J. , Hrsg. Pain: a textbook for health professionals. 3^th . Amsterdam: Elsevier; 2024
• 7 Engel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science 1977; 196: 129-136
• 8 Treede R-D, Rief W, Barke A. et al. Chronic pain as a symptom or a disease: the IASP Classification of Chronic Pain for the International Classification of Diseases (ICD-11). Pain 2019; 160: 19-27
• 9 Moseley GL, Leake HB, Beetsma AJ. et al. Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies. J Pain 2023; 104425
• 10 Saracoglu I, Akin E, Aydin Dincer GB. Efficacy of adding pain neuroscience education to a multimodal treatment in fibromyalgia: A systematic review and meta-analysis. Int J Rheum Dis 2022; 25: 394-404
• 11 Watson JA, Ryan CG, Cooper L. et al. Pain Neuroscience Education for Adults with Chronic Musculoskeletal Pain: A Mixed-Methods Systematic Review and Meta-Analysis. J Pain 2019; 20: 1140.e1-1140.e22
• 12 Corp N, Mansell G, Stynes S. et al. Evidence‐based treatment recommendations for neck and low back pain across Europe: A systematic review of guidelines. Euro J Pain 2021; 25: 275-295
• 13 Zambelli Z, Halstead EJ, Iles R. et al. The 2021 NICE guidelines for assessment and management of chronic pain: A cross-sectional study mapping against a sample of 1,000* in the community. Brit J Pain 2022; 16: 439-449
• 14 Louw A, Puentedura EJ, Zimney K. et al. The clinical implementation of pain neuroscience education: A survey study. Physiother Theorie & Practice 2017; 33: 869-879
• 15 Eysenbach G. Improving the Quality of Web Surveys: The Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6: e34
• 16 Sammut R, Griscti O, Norman IJ. Strategies to improve response rates to web surveys: A literature review. International Journal of Nursing Studies 2021; 123: 104058
• 17 Lin K-Y, Tsai Y-J, Yang J-F. et al. Physical therapists’ experiences and perceptions of antepartum and postpartum care. BMC Pregnancy Childbirth 2022; 22: 176
• 18 Moseley GL, Butler DS. Explain pain supercharged: the clinicianʼs manual. Adelaide: Noigroup Publications; 2017
• 19 Mota da Silva T, da Cunha Menezes Costa L, Garcia AN. et al. What do physical therapists think about evidence-based practice? A systematic review. Manual Ther 2015; 20: 388-401
• 20 Zangoni G, Thomson OP. ‘I need to do another course’ – Italian physiotherapists’ knowledge and beliefs when assessing psychosocial factors in patients presenting with chronic low back pain. Musculoskel Science & Practice 2017; 27: 71-77
• 21 Findeis A, Patyk M. Guidelines for Developing Patient Education Materials. In: Mechanick JI, Kushner RF. ed.  Creating a Lifestyle Medicine Center. Cham: Springer International Publishing; 2020: 145-160
• 22 R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. 2022 Accessed February 22, 2023 at: https://www.r-project.org
• 23 Posit team. RStudio: Integrated Development Environment for R. Posit Software. 2022 Accessed February 22, 2023 at: https://posit.co/
• 24 Merçay C, Grünig A, Dolder P. Gesundheitspersonal in der Schweiz – Nationaler Versorgungsbericht 2021: Bestand, Bedarf, Angebot und Massnahmen zur Personalsicherung (Obsan Bericht 03/2021). Schweizerisches Gesundheitsobservatorium (Obsan); 2021.
• 25 Adam AM. Sample Size Determination in Survey Research. JSRR 2020; 90-97
• 26 Stelljes R, Weber E, Roesner A. Physiotherapeutische Kenntnisse, Fertigkeiten und Kompetenzen in der Versorgung von Menschen mit chronischen Schmerzen. Schmerz 2022; 36: 284-292
• 27 Mirzaei A, Carter SR, Patanwala AE. et al. Missing data in surveys: Key concepts, approaches, and applications. Research in Social and Administrative Pharmacy 2022; 18: 2308-2316
• 28 Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis?. Qualitative Res Psychol 2021; 18: 328-352
• 29 Butler DS, Moseley GL. Schmerzen verstehen: mit 99 Abbildungen. 3. Aufl.. Berlin Heidelberg: Springer; 2016
• 30 Butler DS, Moseley GL. Explain Pain. 2. Aufl.. Noigroup Publications; 2013
• 31 Briggs EV, Battelli D, Gordon D. et al. Current pain education within undergraduate medical studies across Europe: Advancing the Provision of Pain Education and Learning (APPEAL) study. BMJ Open 2015; 5: e006984
• 32 Briggsl EV, Carrl ECJ, Whittakerl MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Euro J Pain 2011; 15: 789-795
• 33 Ehrström J, Kettunen J, Salo P. Physiotherapy pain curricula in Finland: a faculty survey. Scan J Pain 2018; 18: 593-601
• 34 Leegaard M, Valeberg BT, Haugstad GK. et al. Survey of Pain Curricula for Healthcare Professionals in Norway. Nordic J Nursing Res 2014; 34: 42-45
• 35 Miró J, Castarlenas E, Solé E. et al. Pain curricula across healthcare professions undergraduate degrees: a cross-sectional study in Catalonia, Spain. BMC Med Edu 2019; 19: 307
• 36 Tatikola SP, Natarajan V, Amaravadi SK. et al. Effect of pain neuroscience education+ (PNE+) in people with different mechanisms of chronic pain: A systematic review and meta-analysis. J Bodywork & Movement Ther 2025; 41: 215-237
• 37 Tsetseri M-N, Keene DJ, Silman AJ. et al. Exploring the burden, prevalence and associated factors of chronic musculoskeletal pain in migrants from North Africa and Middle East living in Europe: a scoping review. BMC Public Health 2024; 24: 769
• 38 Federal Statistical Office. Reasons for migration and conditions upon arrival: differences by nationality groups. Neuchâtel: Federal Statistical Office; 2019. Accessed January 27, 2025 at: https://dam-api.bfs.admin.ch/hub/api/dam/assets/10489612/master
• 39 Bourne LE, Kole JA, Healy AF. Expertise: defined, described, explained. Front Psychol 2014; 5
• 40 Augeard N, Bostick G, Miller J. et al. Development of a national pain management competency profile to guide entry-level physiotherapy education in Canada. Can J Pain 2022; 6: 1-11
• 41 Fishman SM, Young HM, Lucas ArwoodE. et al. Core Competencies for Pain Management: Results of an Interprofessional Consensus Summit. Pain Med 2013; 14: 971-981
• 42 Reezigt R, Beetsma A, Köke A. et al. Toward consensus on pain-related content in the pre-registration, undergraduate physical therapy curriculum: a Delphi-study. Physiother Theory & Practice 2024; 40: 1040-1053
• 43 Stone AA, Schneider S, Smyth JM. et al. A population-based investigation of participation rate and self-selection bias in momentary data capture and survey studies. Curr Psychol 2024; 43: 2074-2090
• 44 World Medical Association, Hrsg. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. World Medical Association. 2024 Accessed January 27, 2025 at: www.wma.net/policies-post/wma-declaration-of-helsinki/
• 45 Diethold JME, Watzlawik M, Hornstein RR. Die Erfassung von Geschlecht: Bisherige Praxis und Empfehlungen für Neuerungen aus community-basierter Forschung. Diagnostica 2023; 69: 86-98