Pain Resilience Therapy vs. Pain Neuroscience Education for Adults with Chronic Low Back Pain: Secondary Analysis of Data from a Randomized Controlled Trial of Risk and Resilience Factors

Background: Chronic low back pain (CLBP) is associated with psychological risk and resilience factors that drive pain, distress, and disability. Pain Resilience Therapy (PRT) is a novel strengths-based approach; however, its risk and resilience outcomes compared with recognized approaches remain unclear. Objective: To examine the effectiveness of PRT compared to Pain Neuroscience Education (PNE) on psychological risk and resilience factors in adults with CLBP. Design: Secondary data analysis from a randomized controlled trial. Methods: This secondary analysis included data from 60 adults with CLBP randomized to eight telehealth sessions of PRT or PNE delivered over four weeks. Psychological risk and resilience factors were assessed at baseline and at the 90-day follow-up using the OSPRO-YF, which estimates scores of 11 validated questionnaires across three domains: negative mood, negative/maladaptive coping, and positive affect/coping. Between-group differences were examined using ANCOVA with baseline adjustment. Treatment response was quantified using relative risk, absolute risk reduction, and number needed to treat. Results: PRT produced significantly greater improvements than PNE across eight of eleven outcomes, including anxiety, fear avoidance, pain catastrophizing, kinesiophobia, pain-related anxiety, self-efficacy for rehabilitation, and pain acceptance, with medium-to-large effect sizes (ηp2 = 0.088–0.316). Both groups improved in depressive symptoms and pain self-efficacy. Trait anger did not significantly change in either group. The number needed to treat for PRT was 2 for self-efficacy for rehabilitation and 3 for pain catastrophizing, kinesiophobia, and pain acceptance. Conclusions: PRT demonstrated greater effectiveness across eight psychological risk and resilience factors than PNE, warranting further investigation in larger trials.