Understanding the Evidence-to-Practice Gap in Persistent Pain Management

Despite advances in pain science education, evidence-based approaches to chronic pain are not consistently translated into physical therapy practice. Physical therapist (PT) clinical instructors (CIs) occupy a unique role as both clinicians and mentors of future practitioners. This study examined PT CIs' pain knowledge, pain-related beliefs, confidence, and self-reported use of pain neuroscience education (PNE) and explored perceived barriers to implementing evidence-informed persistent pain management and preparing students to care for individuals with persistent pain.

This convergent mixed-methods study used an anonymous online survey to collect quantitative and qualitative data from 30 PT CIs. Quantitative measures assessed pain neurophysiology knowledge, pain-related beliefs, pain care confidence, and reported use of PNE. Open-ended responses explored challenges in chronic pain management and student mentorship. Quantitative data were summarized descriptively, qualitative responses were analyzed using reflexive thematic analysis, and findings were integrated through SCT to examine factors contributing to the evidence-to-practice gap.

Participants demonstrated high pain care confidence, moderate-to-high pain neurophysiology knowledge, low disability-oriented beliefs, and moderate use of PNE. Qualitative themes identified challenges in pain communication, management of complex presentations, and patient engagement that are compounded by clinical constraints. CIs also perceived that students possessed foundational pain knowledge but struggled to apply it through communication, treatment progression, and PNE. Integrated findings revealed a mismatch between knowledge and confidence and the application of biopsychosocial pain management.

The evidence-to-practice gap in chronic pain management may reflect more than inadequate pain knowledge. While CIs reported strong confidence and generally contemporary beliefs, they continued to experience difficulty with communication, adaptability, patient engagement, and implementation within constrained clinical environments. Strategies to improve pain management should therefore extend beyond knowledge acquisition and include applied communication training, context-sensitive clinical decision-making, and support for clinicians who model pain care for future PTs.