This randomized controlled trial aims to evaluate the effectiveness of the "Algo(S)Therapy" Pain Neuroscience Education (PNE) program in patients with chronic musculoskeletal pain. The study will assess whether the integration of communication skills training for physiotherapists enhances the outcomes of PNE. Participants will be randomly assigned to one of three groups: (1) PNE with communication-focused delivery, (2) PNE without communication emphasis, or (3) standard- usual physiotherapy care. The primary objective is to determine whether PNE combined with enhanced communication skills leads to greater improvements in pain, function, and psychosocial outcomes compared to the other interventions.
Adults aged 18 to 65 years
Diagnosis of chronic musculoskeletal pain in the lumbar spine, cervical spine, shoulder, or knee
Pain duration longer than 3 months
Pain intensity ≥3/10 on the Numeric Pain Rating Scale (NPRS)
Acute pain in any body region
Neurological disorders or myopathies
Chronic pain of non-musculoskeletal origin
Active cancer diagnosis
Parallel
Pain Neuroscience Education with Communication Training
BehavioralThis intervention includes individualized physiotherapy based on a Pain Neuroscience Education (PNE) framework delivered by physiotherapists who completed the full "Algo(S)Therapy" training program. The training includes education in the neurophysiology of pain, clinical reasoning for chronic musculoskeletal pain management, and structured communication skills development (e.g., motivational interviewing, empathy, active listening). The intervention is delivered twice per week over 5 weeks (10 sessions total).
Pain Neuroscience Education without Communication Training
BehavioralA structured PNE program focusing on the neurophysiology and clinical management of chronic musculoskeletal pain. Delivered by physiotherapists trained only in the scientific modules of the "Algo(S)Therapy" program. Does not include communication skills training. Includes 10 sessions (2/week for 5 weeks), alongside standard physiotherapy care.
Usual Physiotherapy Treatment
BehavioralUsual care based on medical referral and physiotherapy assessment. Delivered by physiotherapists who have not received training in Pain Neuroscience Education or communication techniques. No components of the "Algo(S)Therapy" program are included.
Numeric Pain Rating Scale - NPRS
Pain intensity will be assessed using the Numeric Pain Rating Scale (NPRS), where participants rate their average pain on a scale from 0 (no pain) to 10 (worst imaginable pain). The measure will be used to determine the effectiveness of each intervention in reducing chronic musculoskeletal pain.
Central Sensitisation Inventory (CSI)
The CSI assesses symptoms related to central sensitization in chronic pain conditions. The score ranges from 0 to 100, with higher scores indicating greater sensitization.
Pain Catastrophizing Scale (PCS)
The PCS evaluates negative cognitive and emotional responses to pain, including rumination, magnification, and helplessness. Scores range from 0 to 52, with higher scores indicating greater levels of pain catastrophizing. This measure helps assess the psychological effect of the intervention.
Tampa Scale for Kinesiophobia (TSK)
The TSK measures fear of movement or re-injury, which can limit function in individuals with chronic pain. Scores range from 17 to 68, with higher scores reflecting greater kinesiophobia. This outcome examines whether the intervention improves patients' movement confidence.
Pain Sensitivity Questionnaire (PSQ)
The PSQ assesses self-reported pain sensitivity through imagined everyday painful situations. It helps identify individuals with increased pain perception, a factor often present in chronic pain conditions. The total score ranges from 0 to 10, with higher scores indicating greater pain sensitivity. This outcome evaluates whether the intervention influences pain sensitivity levels.
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