From didactic explanations to co-design, sequential art and embodied learning: challenges, criticisms and future directions of patient pain education.

Pain Neuroscience Education (PNE) emerged over two decades ago in response to the incoherence between evidence-based pain management strategies, and consumer and clinician understandings of "how pain works". Many clinical trials have investigated the effects of PNE either as a standalone intervention or embedded within a more complex care package, with mixed results. A range of research methods have been used to explore the inconsistent effects of PNE. Together they (i) identify significant shortcomings and limitations of PNE and (ii) raise the possibility that gaining a broadly scientifically accurate understanding of "how pain works" may be critical for subsequent pain and disability improvements. Both learnings strongly suggest that we need to do better. Extensive research incorporating several interest-holders has led to updated content and language and criticisms of both are addressed. The method of PNE has also been updated, with integration of educational frameworks, teaching strategies and tactics, patient resources and clinical tools that all aim to promote the likelihood that patients will learn key concepts and operationalise them to improve their pain, function and quality of life. Pain Science Education is used to differentiate the new approach from PNE.