Rewiring Pain: Using TNE, PNE, an CFT in the Chronic Pain Population

Understanding the Basics

Pain Neuroscience Education (PNE), also known as Therapeutic Neuroscience Education (TNE), teaches patients about the neurobiology and physiology underlying pain. It explains concepts like central and peripheral sensitization, how the pain neuromatrix functions, neuroplasticity, and why pain often reflects a sensitized nervous system rather than tissue damage. Studies show that PNE can reduce pain, disability, fear-avoidance, and catastrophizing, while enhancing function and physical activity¹ .

Cognitive Functional Therapy (CFT) is a biopsychosocial intervention that integrates cognitive reframing with patient-specific functional movement training. It helps patients rethink how they relate to their pain and gradually reintroduces normal activities through graded exposure, movement retraining, and personalized goal‑setting.

Relevance to Physical Therapy for Chronic Pain

For many chronic pain patients, pain feels like a sign of ongoing tissue damage. PNE helps them understand that the pain is real, but not necessarily a marker of current injury. It reframes pain as the brain’s protective response when it senses threat, neuroplastic changes, or sensitization.

This cognitive shift empowers patients. When they see pain not as permanent damage but as a modifiable output of the nervous system, they often become more willing to engage in movement and activity.

While PNE/TNE provides vital education, it cannot stand alone. It serves as a foundation for functional progression:

• CFT builds on reconceptualized beliefs, coupling education with movement-based strategies to break maladaptive patterns.

• Movement and graded exposure are introduced gradually based on what the patient values, through functional tasks tailored to their goals.

• Pacing, pacing strategies, sleep hygiene, coping techniques, goal‑setting, and mindfulness (sometimes termed “PNE+”) strengthen the effects of education. Evidence shows combining PNE with behavioral and movement-based techniques yields better outcomes than education alone.

Outcomes for those with Chronic Pain:

Research shows PNE improves clinically meaningful outcomes across several domains: reducing pain intensity, fear, catastrophizing, health care utilization, and improving physical function and movement behavior.

CFT has demonstrated significant reductions in pain-related disability, improved physical and psychological function, and enhanced movement confidence for individuals with disabling low back pain.

Why This Matters

Working with chronic pain can wear down even the most dedicated clinicians. It’s easy to become jaded, to see another patient with persistent symptoms and think, “Here we go again.” But every patient’s pain is real, and every nervous system tells a different story.

PNE, TNE, and CFT give us tools to avoid that trap. They help us validate what the patient is experiencing, while also showing them that pain doesn’t always equal damage, and that change is possible. These approaches remind us that chronic pain care is about partnership: educating, coaching, and guiding patients back toward function.

Most importantly, they reinforce that education alone isn’t enough. True progress comes when we pair these strategies with movement, exercise, and graded exposure to help patients and clinicians move past fear and frustration to real outcomes.

Helpful Videos to Get Started

If you’re completely new to PNE and how to talk about it with patients, a few short educational videos can be helpful as a starting point. These clips show clinicians explaining core PNE principles, ideas that overlap closely with TNE and set the stage for concepts used in CFT.

The videos mostly focus on education (without the movement component) and use some tools, like flashcards, that can feel a bit corny. But the message is strong and provides a simple framework to start conversations with patients about how pain does not always equal damage and how understanding this can change their recovery journey.

Even if you don’t use the exact style shown, and I’d suggest you don’t, these examples can help you build confidence in how to communicate the basics of pain neuroscience before integrating movement and functional retraining.

Parting Thoughts

Chronic pain can feel like an endless cycle, for the patient and sometimes for the clinician. But by blending education, cognitive approaches, and functional retraining, physical therapists can break that cycle.

PNE and CFT don’t replace exercise, strength, or conditioning, they make those interventions work better. They help patients shift their mindset, trust their bodies again, and gradually rebuild the confidence and resilience needed to move freely.

At their core, these approaches remind us of the ultimate goal: not just reducing symptoms, but helping people return to living lives defined by their goals, not their pain.

References:

1. 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):160-168. doi:10.1080/10669817.2017.1323699

2. O'Sullivan PB, Caneiro JP, O'Keeffe M, et al. Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Phys Ther. 2018;98(5):408-423. doi:10.1093/ptj/pzy022

Disclaimer:

I am a current Doctor of Physical Therapy (DPT) student sharing information based on my formal education and independent studies. The content presented in this newsletter is intended for informational and educational purposes only and should not be considered professional medical advice. While I strive to provide accurate and up-to-date information, my knowledge is based on my current academic and clinical rotations and ongoing learning, not extensive clinical practice.