Pain Neuroscience Education to Reduce Catastrophizing: A Parallel Randomized Trial in Youth Athletes
Source abstract
Abstract
In sport, pain is often normalized, leading athletes to train or compete despite discomfort. This can shape their response to pain, with catastrophizing potentially triggering fear of movement, avoidance behaviors, and increased pain. While previous research has examined the relationship between pain and catastrophizing in individuals with chronic pain, few studies have explored these effects in the sports population. This study investigated the effects of a pain neuroscience educational program on catastrophizing and injury rates in youth female and male athletes. This parallel randomized trial included an intervention group (IG) and a control group (CG), both undergoing a 12-week program on healthy habits in sport. The IG received additional pain neuroscience information. Catastrophizing levels were collected before and after using the Pain Catastrophizing Scale. Injury rates were registered during the study. The results revealed a decrease in catastrophizing levels in the IG compared to baseline (p = 0.028, d = 0.32, 95%CI [0.03, 0.61]). In the IG, only males showed improvements (p = 0.041, d = 0.47, 95%CI [0.08, 0.86]). Injury rates were similar between groups (CG = 26.2%, IG = 27.8%; p > 0.05). Pain education may reduce catastrophizing in youth athletes, particularly males, although effects may vary by sex and context.
Source: crossref · Quality: baseline
Research context
OpenAlex topics: Musculoskeletal pain and rehabilitation · Pain Mechanisms and Treatments · Sport Psychology and Performance
SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.
Affiliations
Department of Nursing and Physiotherapy, University of the Balearic Islands, 07122 Palma de Mallorca, Spain
Health Research Institute of the Balearic Islands (IdISBa), 07122 Palma de Mallorca, Spain
References (56)
Show source-provided references
1. The Biopsychosocial Approach to Chronic Pain: Scientific Advances and Future Directions10.1037/0033-2909.133.4.581 ↗
2. Catastrophizing and Pain Perception in Sport Participants10.1080/10413200008404220 ↗
3. What Is the Relationship of Fear Avoidance to Physical Function and Pain Intensity in Injured Athletes?10.1007/s11999.0000000000000085 ↗
4. Tawil, S., Kassis, V., Bassil, T., Farhat, K., Hourani, E., Massoud, L., and Najem, C. (2025). Intermediary Role of Mental Toughness Beliefs on the Relationship between Pain Self-Efficacy and Fear Avoidance in Elite Injured Athletes. BMC Sports Sci. Med. Rehabil., 17.10.1186/s13102-025-01171-w ↗
5. Psychosocial Impacts of Sports-Related Injuries in Adolescent Athletes10.1249/JSR.0000000000000809 ↗
6. Pain Catastrophizing: A Critical Review10.1586/ern.09.34 ↗
7. Central Sensitization and Catastrophism Symptoms Are Associated with Chronic Myofascial Pain in the Gastrocnemius of Athletes10.1093/pm/pnz296 ↗
8. The Revised IASP Definition of Pain: Concepts, Challenges, and Compromises10.1097/j.pain.0000000000001939 ↗
9. Perceptions of Low Back Pain in Elite Gymnastics: A Multi-Disciplinary Qualitative Focus Group Study. Phys10.1016/j.ptsp.2020.04.003 ↗
10. Timpka, T., Jacobsson, J., Bargoria, V., and Dahlström, Ö. (2019). Injury Pain in Track and Field Athletes: Cross-Sectional Study of Mediating Factors. Sports, 7.10.3390/sports7050110 ↗
11. Yokoe, T., Tajima, T., Yamaguchi, N., Nagasawa, M., Ota, T., Morita, Y., and Chosa, E. (2021). Orthopaedic Medical Examination for Young Amateur Athletes: A Repeated Cross-Sectional Study from 2014 to 2018. BMJ Open, 11.10.1136/bmjopen-2020-042188 ↗
12. Garbenytė-Apolinskienė, T., Salatkaitė, S., Šiupšinskas, L., and Gudas, R. (2019). Prevalence of Musculoskeletal Injuries, Pain, and Illnesses in Elite Female Basketball Players. Medicina, 55.10.3390/medicina55060276 ↗
13. Farì, G., Fischetti, F., Zonno, A., Marra, F., Maglie, A., Bianchi, F.P., Messina, G., Ranieri, M., and Megna, M. (2021). Musculoskeletal Pain in Gymnasts: A Retrospective Analysis on a Cohort of Professional Athletes. Int. J. Environ. Res. Public Health, 18.10.3390/ijerph18105460 ↗
14. Sastre-Munar, A., Pades-Jiménez, A., García-Coll, N., Molina-Mula, J., and Romero-Franco, N. (2022). Injuries, Pain, and Catastrophizing Level in Gymnasts: A Retrospective Analysis of a Cohort of Spanish Athletes. Healthcare, 10.10.3390/healthcare10050890 ↗
15. Prevalence of musculoskeletal pain among swimmers in an elite national tournament
16. Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations10.1097/JSM.0000000000000601 ↗
17. Current Clinical Concepts: Integration of Psychologically Informed Practice for Management of Patients with Sport-Related Injuries10.4085/1062-6050-0556.22 ↗
18. Cognitive-Behavioral-Based Physical Therapy to Enhance Return to Sport after Anterior Cruciate Ligament Reconstruction: An Open Pilot Study10.1016/j.ptsp.2020.01.004 ↗
19. Pain in Elite Athletes—Neurophysiological, Biomechanical and Psychosocial Considerations: A Narrative Review10.1136/bjsports-2017-097890 ↗
20. The Efficacy of Pain Neuroscience Education on Musculoskeletal Pain: A Systematic Review of the Literature10.1080/09593985.2016.1194646 ↗
21. Short-Term Impact of Combining Pain Neuroscience Education with Exercise for Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis10.1097/j.pain.0000000000002308 ↗
22. Patient education for patellofemoral pain: A systematic review10.2519/jospt.2020.9400 ↗
23. Effects of mindfulness practice on performance-relevant parameters and performance outcomes in sports: A meta-analytical review10.1007/s40279-017-0752-9 ↗
24. A sports-based youth development program, teen mental health, and physical fitness: An RCT10.1542/peds.2017-1543 ↗
25. Lochbaum, M., Stoner, E., Hefner, T., Cooper, S., Lane, A.M., and Terry, P.C. (2022). Sport psychology and performance meta-analyses: A systematic review of the literature. PLoS ONE, 17.10.1371/journal.pone.0263408 ↗
26. Effect of mindfulness-based programmes on elite athlete mental health: A systematic review and meta-analysis10.1136/bjsports-2022-105596 ↗
27. Wilczyńska, D., Qi, W., Jaenes, J.C., Alarcón, D., Arenilla, M.J., and Lipowski, M. (2022). Burnout and mental interventions among youth athletes: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health, 19.10.20944/preprints202208.0100.v1 ↗
28. A conditional process model of the effect of mindfulness on 800-m personal best times through pain catastrophising10.1080/02640414.2015.1093648 ↗
29. The relationship of gender to pain, pain behavior, and disability in osteoarthritis patients: The role of catastrophizing10.1016/S0304-3959(00)00296-7 ↗
30. Personality factors in the explanation of sex differences in pain catastrophizing and response to experimental pain10.1097/00002508-200409000-00001 ↗
31. Estimación Del Tamaño de La Muestra En La Investigación Clínica y Epidemiológica
32. Javdaneh, N., Saeterbakken, A.H., Shams, A., and Barati, A.H. (2021). Pain neuroscience education combined with therapeutic exercises provides added benefit in the treatment of chronic neck pain. Int. J. Environ. Res. Public Health, 18.10.3390/ijerph18168848 ↗
33. Defining Minimal Clinically Important Differences in Pain and Disability Outcomes of Patients with Chronic Pain Treated with Spinal Cord Stimulation10.3171/2020.11.SPINE201431 ↗
34. International Olympic Committee consensus statement: Methods for recording and reporting of epidemiological data on injury and illness in sport 202010.1136/bjsports-2019-101969 ↗
35. Validación de la escala de catastrofismo ante el dolor (Pain Catastrophizing Scale) en deportistas españoles10.4321/S1578-84232013000100009 ↗
36. The Oslo Sports Trauma Research Center Questionnaire on Health Problems: A New Approach to Prospective Monitoring of Illness and Injury in Elite Athletes10.1136/bjsports-2012-092087 ↗
37. Effect of intensive patient education vs placebo patient education on outcomes in patients with acute low back pain: A randomized clinical trial10.1001/jamaneurol.2018.3376 ↗
38. The effect of pain neuroscience education on sports therapy and rehabilitation students’ knowledge, attitudes, and clinical recommendations toward athletes with chronic pain10.1123/jsr.2017-0212 ↗
39. Fifteen Years of Explaining Pain: The Past, Present, and Future10.1016/j.jpain.2015.05.005 ↗
40. Infographic. Pain or Injury? Why Differentiation Matters in Exercise and Sports Medicine10.1136/bjsports-2021-104633 ↗
41. Sánchez-Díaz, S., Yanci, J., Castillo, D., Scanlan, A.T., and Raya-González, J. (2020). Effects of Nutrition Education Interventions in Team Sport Players. A Systematic Review. Nutrients, 12.10.3390/nu12123664 ↗
42. Let’s talk about sleep: A systematic review of psychological interventions to improve sleep in college students10.1111/jsr.12568 ↗
43. Pain Perception in Athletes Compared to Normally Active Controls: A Systematic Review with Meta-Analysis10.1016/j.pain.2012.03.005 ↗
44. Progressive statistics for studies in sports medicine and exercise science10.1249/MSS.0b013e31818cb278 ↗
45. Does changing pain-related knowledge reduce pain and improve function through changes in catastrophizing?10.1097/j.pain.0000000000000472 ↗
46. Can crafted communication strategies allow musculoskeletal specialists to address health within the biopsychosocial paradigm?10.1097/CORR.0000000000001635 ↗
47. Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis10.1016/j.jpain.2019.02.011 ↗
48. Return to Advanced Strength Training and Weightlifting in an Athlete Post-Lumbar Discec-Tomy Utilizing Pain Neuroscience Education and Proper Progression: Resident’s Case Report10.26603/ijspt20190804 ↗
49. Pain catastrophizing in college athletes10.1123/jsr.2018-0137 ↗
50. Complex systems approach for sports injuries: Moving from risk factor identification to injury pattern recognition10.1136/bjsports-2015-095850 ↗
51. Pain-related rumination, but not magnification or helplessness, mediates race and sex differences in experimental pain10.1016/j.jpain.2016.11.005 ↗
52. Catastrophizing as a mediator of sex differences in pain: Differential effects for daily pain versus laboratory-induced pain10.1016/j.pain.2004.07.012 ↗
53. Sex differences in pain: A brief review of clinical and experimental findings10.1093/bja/aet127 ↗
54. A systematic literature review on sex/gender and pain perception: Do biopsychosocial factors alter pain sensitivity differently in women and men?10.1016/j.pain.2011.11.026 ↗
55. Lepri, B., Romani, D., Storari, L., and Barbari, V. (2023). Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: A systematic review. Int. J. Environ. Res. Public Health, 20.10.3390/ijerph20054098 ↗
56. Prospective Research in Health Service Settings: Health Psychology, Science and the Hawthorne’ Effect10.1177/1359105304042345 ↗