Document Type : short communication


1 Larner College of Medicine, University of Vermont, Burlington, Vermont, United States of America

2 Pediatric Neurology, University of Vermont Medical Center, Burlington, Vermont, United States of America


Background: Pain neuroscience education (PNE) improves the functional outcomes of adults with chronic pain, and may also benefit children with chronic pain. We assessed pediatric primary headache patients’ baseline understanding of PNE through interviews and standardized questionnaires, and piloted an educational intervention using a 3D brain model.
Methods: Seventeen patients, aged 12-18 with primary headaches, completed the interview, pre-intervention Concept of Pain Inventory (COPI), and an educational session. Twelve of these participants completed the post-intervention COPI. The patients completed the validated COPI at a regular clinic visit, and completed interviews focused on their concepts of and relation to their pain symptoms, used to tailor education to individual understanding. PNE included a presentation of a 3D-printed brain model (printed from a brain MRI) and a ten-minute discussion. The session concluded with a post-intervention COPI to gauge the intervention’s impact on the subjects’ views of primary headache.
Results: Comparison of pre- and post- intervention COPI scores revealed an average 9.5 point score increase (p=0.002). Overall low pre-intervention scores suggested a low baseline alignment with the concepts of PNE, additionally supported by the interview answers. The participants were generally interested in learning more about PNE, and were teachable as indicated by the significant COPI score increase.
Conclusions: Pediatric primary headache patients are typically not well-versed in central concepts of PNE, but interactive sessions can increase understanding. 3D brain models can be an effective vehicle for delivering PNE. These findings support further research on the efficacy of PNE in the setting of pediatric headache.


  1. Faedda N, Cerutti R, Verdecchia P, Migliorini D, Arruda M, Guidetti V. Behavioral management of headache in children and adolescents. J Headache Pain 2016; 17(80).
  2. Powers SW, Patton SR, Hommel KA, Hershey AD. Quality of life in childhood migraines: clinical impact and comparison to other chronic illnesses. Pediatrics 2003; 112: e1 – e5.
  3. Robins H, Perron V, Heathcote LC, Simons LE. Pain Neuroscience Education: State of the Art and Application in Pediatrics. Children (Basel) 2016; 3(4): 43.
  4. Samson, K. For Your Patients-Back Pain: Neuroscience Education Plus Targeted Exercise Improves Back Pain Outcomes. Neurol Today 2018; 18: 28 – 31.
  5. Abram HS, Buckloh LM, Schilling LM, Wiltrout SA, Ramírez-Garnica G, Turk WR. A randomized, controlled trial of a neurological and psychoeducational group appointment model for pediatric headaches. Child Health 2007; 36(3): 249 – 265.
  6. Pate JW, Simons LE, Hancock MJ, Hush JM, Noblet T, Pounder M, Pacey V. The Concept of Pain Inventory (COPI): Assessing a Child's Concept of Pain. Clin J Pain 2020; 36: 940 – 949.
  7. Heathcote LC, Pate JW, Park AL, Leake HB, Moseley GL, Kronman CA, Fischer M, Timmers I, Simons LE. Pain neuroscience education on YouTube. PeerJ 2019; 7: e6603.
  8. Coakley R, Schechter N. Chronic pain is like ... The clinical use of analogy and metaphor in the treatment of chronic pain in children. Pediatr Pain Lett 2013; 15: 1 – 8.
  9. Harpole LH, Samsa GP, Jurgelski AE, Shipley JL, Bernstein A, Matchar DB. Headache management program improves outcome for chronic headache. J Head Face Pain 2003; 43(7): 715 – 724.
  10. Blumenfeld, A, Tischio, M. Center of excellence for headache care: Group model at Kaiser Permanente. Headache 2003; 43: 431 – 440.
  11. Louw A, Zimney K, Puentedura EJ, Diener I. The Efficacy of Pain Neuroscience Education on Musculoskeletal Pain: A Systematic Review of the Literature. Physiother Theory Pract 2016; 32: 332 – 355.
  12. Larsson, B, Carlsson, J, Fichtel, A, Melin, L. Relaxation treatment of adolescent headache sufferers: Results from a school-based replication series. Headache 2005; 45: 692 – 704.
  13. Holden, EW, Deichmann, MM, Levy, JD. Empirically supported treatments in pediatric psychology: Recurrent pediatric headache. J Pediatr Psychol 1999; 24: 91 – 109.
  14. McGrath, PJ, Humphreys, P, Keene, D, Goodman, JT, Lascelles, MA, Cunningham, SJ, et al. The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain 1992; 49: 321 – 324.
  15. Eccleston C, Morley S, Williams A, Yorke L, Mastroyannopoulou K. Systematic Review of Randomized Controlled Trials of Psychological Therapy for Chronic Pain in Children and Adolescents, with a Subset Meta-Analysis of Pain Relief. Pain (Amsterdam) 2002; 99: 157 – 165.